儿童社区获得性肺炎病原学调查及耐药性分析  

Pathogens and Antibiotic Resistance in Children with Community-Acquired Pneumonia in Our Hospital

作　　者：郭磊[1] 丁效国[1] 

机构地区：[1]新疆生产建设兵团医院,新疆乌鲁木齐830002

出　　处：《儿科药学杂志》2014年第7期42-45,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨我院儿童社区获得性肺炎(CAP)的病原学特点及耐药情况,为指导临床合理使用抗感染药物提供参考。方法:对2009年6月至2012年6月住院治疗的478例CAP患儿,分别采集呼吸道分泌物和静脉血进行检测。呼吸道分泌物进行细菌学培养及致病菌耐药性分析,实时聚合酶链反应法(RT-PCR)检测肺炎支原体(MP)、肺炎衣原体(CP)及沙眼衣原体(CT);酶联免疫吸附法(ELISA)检测静脉血中病毒IgM抗体。结果:478例CAP患儿共检出病原体352株(73.64%)。细菌培养阳性214例(44.77%),其中检出革兰阴性菌95例;病毒检测阳性112例(23.43%);MP检测阳性137例(28.66%);混合感染126例(26.36%),其中细菌+病毒47例(9.83%)。细菌感染中以肺炎链球菌和流感嗜血杆菌为主,病毒感染则以呼吸道合胞病毒(RSV)为主。检出的前三位革兰阳性菌对青霉素、头孢唑林、红霉素及克林霉素耐药率较高,对万古霉素及利奈唑胺100%敏感。前三位革兰阴性菌对氨苄西林及第二、三代头孢菌素耐药率较高,对亚胺培南、氨曲南、阿米卡星及头孢哌酮/舒巴坦敏感性较高。结论:我院CAP患儿细菌检出率较高,以革兰阴性菌为主,且对常用抗菌药物产生了较高的耐药性。Objective： To investigate the characteristics of pathogens and antibiotic resistance in children with community-acquired pneumonia so as to provide references of rational use of antibiotics. Methods： Four hundreds and seventy-eight cases of children with CAP from June 2009 to June 2012 were selected,and respiratory secretion and venous blood samples were obtained. The bacterial culture and drug resistance analysis of pathogenic bacteria were performed. Mycoplasma pneumonia,Chlamydia pneumonia and Chlamydia trachomatis were detected by RT-PCR in respiratory secretion. IgM antibody was tested using ELISA. Results： The pathogens were detected in 352（ 76. 64%） cases,which included 214 cases of bacteria,112 cases（ 23. 43%） of virus and 137 cases（ 28. 66%）of Mycoplasma pneumonia. There were 126 cases of mixed infection（ 26. 36%）,of which infections of bacteria and virus were 47 cases（ 9.83%）. The pathogens of bacterial infection mainly were Haemophilus influenzae and Streptococcus pneumoniae,and virus infections mainly caused by Respiratory syncytial virus（ RSV）. Antibiotic resistance of the main Gram-positive bacteria to penicillin,cefazoline,erythromycin and clindamycin were particularly common,while vancomycin and linezolid presented high sensitivity. For the Gramnegative bacteria,ampicillin,the second and third generation cephalosporin had high antibiotic resistance rate,but imipenem,aztreonam,amikacin and cefoperazone sulbactam showed 100% sensitivity. Conclusions： The dominant pathogen in our hospitalized children with CAP is bacteria,and Gram-negative bacteria infection is the commonest strain. There is high antibiotic-resistant rate to common used antibacterial agents in these pathogenic bacteria.

关 键 词：儿童 社区获得性肺炎 病原体 耐药性 

分 类 号：R725.6[医药卫生—儿科]