儿童院内和社区获得性肺炎的病原菌及耐药性对比分析  

Comparative Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Children with Hospital and Community-acquired Pneumonia

作　　者：孙萍[1] 颜婷[1] 吴颖[1] 

机构地区：[1]南昌大学第一附属医院儿科,南昌330006

出　　处：《南昌大学学报（医学版）》2011年第10期34-38,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的分析院内获得性肺炎(hospital acquired pneumonia,HAP)和社区获得性肺炎(communital acquired pneumonia,CAP)痰病原菌的分布及药敏情况,以指导临床对肺炎患儿早期合理用药。方法对2008年6月至2011年6月住院诊断为肺炎及至少一次痰培养阳性的患儿,就病原菌和耐药情况进行回顾性分析。结果 267例均为同期诊断为肺炎的住院痰培养阳性患儿,其中HAP 64例,CAP 203例。HAP患儿分离出100株病原菌,其中革兰阳性菌15株(15.00%),革兰阴性菌70株(70.00%),真菌15株(15.00%);前3位的病原体依次是肺炎克雷伯菌25株(25.00%),鲍曼不动杆菌15株(15.00%)及凝固酶阴性葡萄球菌11株(11.00%),混合感染占48.40%。CAP患儿分离出208株病原菌,革兰阳性菌46株(22.12%),革兰阴性菌157株(75.48%),真菌5株(2.40%);前3位的病原体依次是肺炎克雷伯菌65株(31.25%),大肠埃希菌32株(15.39%),肺炎链球菌19株(9.14%),混合感染占2.46%。药敏结果显示HAP病原菌对常用抗生素的耐药性多明显高于CAP(P<0.01或P<0.05),但革兰阳性球菌对万古霉素均敏感,革兰阴性细菌对头孢哌酮/舒巴坦、亚胺培南及美罗培南敏感。结论 HAP患儿痰培养的病原菌产酶菌株多,细菌耐药率高,治疗困难。了解肺炎患儿病原菌的分布和耐药情况,可指导临床合理用药,提高抢救成功率。Objective To analyze the distribution and antimicrobial susceptibility of pathogens responsible for hospital-acquired pneumonia（HAP）and community-acquired pneumonia （CAP） in order to guide the initial selection of appropriate antibiotics for children with pneumonia. Methods A retrospective chart review was conducted to analyze the distribution and antimicrobial suscepti bility of pathogens in hospitalized children with pneumonia and at least one positive result of sputum culture from June 2008 to June 2011. Results Among the 267 children with pneumonia,64 were HAP and 203 were CAP. One hundred pathogens were isolated in children with HAP, including 15 strains of gram-positive bacteria （15. 00%）, 70 strains of gram-negative bacteria （70.00 % ） and 15 strains of fungi （15. 00%）. The top three pathogens were Klebsiella pneumoniae （25 strains, 25.00% ）, Acinetobacter baumannii（ 15 strains, 15.00 % ） and Coagulase-negative staphylococci （ 11 strains, 11.00 %）. The mixed infection rate was 48.40 %. A total of 208 pathogens were isolated in children with CAP,including 46 strains of gram-positive bacteria （22.12%）, 157 strains of gram-negative bacteria （75.48%） and 5 strains of fungi （2.40%）. The top three pathogens were Klebsiella pneumoniae（65 strains,31.25%）, Nscherichia coli（32 strains, 15.39%） and Streptococcus pneumoniae（19 strains, 9. 14%）. The mixed infection rate was 2. 46%. Drug sensitivity testing displayed that the antibiotic resistance of pathogens responsible for HAP was significantly higher than that responsible for CAP （P〈0.01 or P〈0.05）. Gram-positive cocci were most sensitive to vancomycin. Gram-negative bacteria were most sensitive to cefoperazone/sulbactam,imipenem and meropenem. Conclusion These are multiple enzyme-producing strains in sputa of children with HAP. Isolates are highly resistant to antibiotics and the pneumonia is difficult to treat. Knowing the distribution and drug resistance of pathogens is important for guiding clinical

关 键 词：细菌 院内获得性肺炎 社区获得性肺炎 痰培养 抗药性 儿童 

分 类 号：R725.631.1[医药卫生—儿科]