1～3月龄婴儿下呼吸道感染痰检病原菌分布及耐药分析  

Pathologic bacterial distribution and antibiotic resistance in induced sputum of infants aged from 1 to 3 months with lower respiratory tract infection

作　　者：左满凤[1] 刘贺临[1] 朱木良 舒琼璋[1] 江玲[1] 

机构地区：[1]华中科技大学同济医学院附属孝感医院儿科,湖北孝感432100 [2]华中科技大学同济医学院附属孝感医院检验科,湖北孝感432100

出　　处：《中国当代儿科杂志》2014年第12期1226-1230,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的 了解1~3月龄婴儿下呼吸道感染（LRTI）病原菌的分布及耐药情况,为临床合理选用抗生素提供依据。方法 选取2013年1~12月本院收治的患LRTI的1~3月龄婴儿622例,取痰标本送细菌培养。采用琼脂扩散敏感试验行药敏试验。结果 622份痰标本中共分离到菌株379株,检出率为60.9%,其中革兰阴性菌325株（85.8%）,革兰阳性菌50株（13.2%）,真菌4株（1.1%）。革兰阴性菌主要为大肠埃希菌（31.1%）和肺炎克雷伯菌（18.2%）,产超广谱β内酰胺酶（ESBLs）菌的检出率分别为48.3%和52.2%,且上述两种产ESBLs菌的平均耐药率为53%,对氨苄西林、头孢噻肟耐药率达100%,对碳青霉烯类抗生素均敏感。革兰阳性菌主要为金黄色葡萄球菌（10.0%）,其中耐甲氧西林金黄色葡萄球菌检出比例较低（1.8%）,但对β内酰胺类抗生素100%耐药。结论 1~3月龄婴儿LRTI的病原菌以革兰阴性菌：大肠埃希菌和肺炎克雷伯菌为主,产ESBLs菌检出率达48%以上,平均耐药率达53%以上,可指导临床首次经验性选药,以提高低龄婴儿的治疗有效率和生存率。Objective To investigate the pathologic bacterial distribution and their antibiotic resistance in infants aged from 1 to 3 months with lower respiratory tract infection, so as to provide instructions for clinical application of antibiotics. Methods Induced sputum was extracted from 622 cases of hospitalized infants aged from 1 to 3 months with lower respiratory tract infection between January 2013 and December 2013, and microbial sensitivity test was performed with agar diffusion sensitivity test. Results A total of 379 （60.9%） strains of bacteria were isolated from induced sputum in the 622 infants. The Gram-negative strains were detected in 325 strains （85.8%）, and the Gram- positive strains were found in 50 strains （13.2%） in the 379 strains. The others were Fungal strains （4 strains, 1.1%）. The Gram-negative bacteria included Escherichia coli （31.1%） and Klebsiella pneumoniae （18.2%）, with extended-spectrum 13-1actamases （ESBLs） production of 48.3% and 52.2% respectively. The average rate of antibiotic resistance for ESBLs- producing bacteria was 53%. ESBLs-producing bacteria were highly resistant （100%） to ampicillin and cefotaxime, but sensitive to carbapenems. Staphylococcus aureus （10.0%） was the dominant bacteria in Gram-positive bacteria. A lower proportion of methicillin-resistant Staphylococcus aureus （1.8%） was observed, however the resistance rate of methicillin-resistant Staphylococcus aureus to 13-1actam antibiotics were 100%. Conclusions Escherichia coli and Klebsiella pneumoniae are the main pathogenic bacteria causing lower respiratory tract infection in infants aged from 1 to 3 months. ESBLs-producing bacteria accounted for over 48%, and the antibiotic resistance rate were more than 53% in these infants. These results provide a basis for the first empirical clinical use of antimicrobial in infants with lower respiratory tract infection.

关 键 词：下呼吸道感染 病原菌分布 耐药分析 婴儿 

分 类 号：R446.5[医药卫生—诊断学]