中度持续哮喘伴社区获得性肺炎患儿呼吸道革兰阴性杆菌的分布及耐药性分析  

Distribution and drug resistance of gram-negative bacilli in respiratory tract from mild and continuous attack of asthma children complicated with community-acquired pneumonia

作　　者：蒋颖颖[1] 陈亚萍[1] 周江瑾[1] 

机构地区：[1]宁波市妇女儿童医院儿一科,浙江宁波315012

出　　处：《中华医院感染学杂志》2014年第3期745-747,共3页Chinese Journal of Nosocomiology

基　　金：宁波市农业科技创新创业基金项目(2010C91039)

摘　　要：目的了解中度持续哮喘伴社区获得性肺炎患儿呼吸道革兰阴性杆菌的分布及耐药性,为临床合理治疗提供理论依据。方法回顾性分析2009年1月-2011年12月诊断为中度持续哮喘,伴社区获得性肺炎患儿痰液标本中分离的256株革兰阴性杆菌培养结果,对其菌谱及药物敏感试验结果进行统计分析。结果 256株革兰阴性杆菌中,主要以流感嗜血菌、肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌、铜绿假单胞菌为主,分别占26.6%、22.7%、21.6%、14.8%、5.8%;5种主要革兰阴性杆菌对氨苄西林耐药率最高,均>60.0%,对头孢哌酮/舒巴坦的耐药率最低,均<10.0%,鲍氏不动杆菌和铜绿假单胞菌对亚胺培南的耐药率均为20.0%。结论儿童中度持续哮喘伴社区获得性肺炎的革兰阴性杆菌菌谱与普通儿童社区获得性肺炎和医院获得性肺炎均有所不同,选择抗菌药物时应注意鲍氏不动杆菌对亚胺培南的耐药率呈升高趋势,临床上应加强用药前检测,尤其对可疑重度哮喘患儿,更需对其感染状况进行详细评估,以减少耐药菌株的产生,并提高疗效。OBJECTIVE To investigate the distribution and drug resistance of gram-negative bacilli in the respiratory tract from mild and continuous attack of asthma with community acquired pneumonia（CAP）in children, so as to provide basis for clinical treatment. METHODS The results of the distribution and antibiotic resistance of gram- negative bacilli isolated from sputum specimens from mild and continuous attack of asthma with CAP in children from Jan 2009 to Dec 2011 were analyzed to the bacterial spectrum and drug sensitive test results. RESULTS Among the 256 strains of gram-negative bacilli, the predominant species were Haemophilus influenzae （26.6 %）, Klebsiella pneumoniae （22.7%）, Acinetobactor baumanni （21. 6%）, Escherichia coli （14.8%）, Pseudornonas aeruginosa （5.8%）. The 5 strains of the gram negative bacillus had the high resistance to ampicillin （60.0%） and low resistance to cefoperazone/sulbactam （10.0 %）. The drug resistance rate of A. baumanii and P. aeruginosa to imipenem was 20.0%. CONCLUSION The bacterial spectrum of gram negative bacillus from mild and continuous attack of asthma with CAP in children are different from those of common CAP and hospital acquired pneumonia （HAP）. We should pay attention to the rising trend of the drug resistance of Acinetobacter baumanii to the imipenem. Clinical testing before using this drug should be strengthened. Especially to doubted serious asthma, strengthening monitoring and control of drug resistance are extremely important for rational application of antibiotics and improving curative effect.

关 键 词：儿童 中度持续哮喘 革兰阴性杆菌 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]