孝感地区5岁以下儿童社区获得性肺炎细菌病原学分布及耐药性分析  

Analysis of bacterial distribution and drug resistance in community acquired pneumonia of children under 5 years old in Xiaogan area

作　　者：郑申健[1] 

机构地区：[1]华中科技大学同济医学院附属孝感医院,湖北省孝感市中心医院,湖北孝感432100

出　　处：《实用临床医药杂志》2015年第11期70-73,84,共5页Journal of Clinical Medicine in Practice

摘　　要：目的探讨孝感地区5岁以下儿童社区获得性肺炎细菌病原菌的分布特点和耐药特征。方法选择2013年本院儿科病房收治的5岁以下儿童社区获得性肺炎共计1 022例,统计并分析其痰检病原菌分布及耐药性。结果共分离得到菌株398株,检出率38.94%。其中革兰阴性菌279株(70.1%),革兰阳性菌101株(25.38%),真菌18株(4.52%)。革兰阳性菌主要为金黄色葡萄球菌(10.3%)和肺炎链球菌(9.3%)。革兰阴性菌主要为大肠埃希菌(29.65%)、肺炎克雷伯菌(22.86%),二者主要产超广谱β-内酰胺酶(ESBLs),产酶率分别为53.39%、57.14%。ESBLs阳性菌株对氨苄西林、头孢噻肟100%耐药,对头孢唑林、头孢呋辛的耐药率>80%,对头孢他啶、头孢吡肟和氨曲南的耐药率>50%,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和碳青霉烯类抗菌药物均敏感。结论孝感地区5岁以下儿童社区获得性肺炎细菌病原菌主要是以大肠埃希菌、肺炎克雷伯菌为代表的革兰阴性菌,二者产酶率均在53%以上,平均耐药率达59.5%,应根据药敏情况合理选用抗菌药物。Objective To investigate the clinical distribution and drug resistance characteristics of community acquired pneumonia in children under 5 years old in Xiaogan area. Methods Induced sputum was extracted from 1 022 cases of hospitalized children with infectious community acquired pneumonia collected in 2013 and microbial sensitivity test was performed with agar diffusion sensitivity test. Results 398 strains of bacterial were isolated from induced sputum and the total detection rate was 3 8. 9 4 %. The gram- negative strains were detected in 2 7 9 strains（ 70. 1%）,and the gram-positive strains were detected in 101 strains（ 25. 38%） in these 398 strains,the others were 18 fungal strains（ 4. 52%）. The staphylococcus aureus（ 10. 3%） and streptococcus pneumonia（ 9. 3%） were the dominant bacteria in gram- positive bacteria. The gram-negative bacteria mainly were Escherichia coli（ 2 9. 6 5 %）,Klebsiella pneumoniae（ 2 2. 8 6 %）,which could produce extended-spectrum β-lactamases（ ESBLs,the rates of enzyme production were53. 39% and 57. 14%）. ESBLs-producing bacteria were highly resistance to Ampicillin,Cefotaxime（ the resistance rate were 100%）,and the resistance rates to cefazolin and cefuroxime 80%,and the resistance rates to ceftazidime,cefepime,aztreonam 〉50%,but they were sensitive to cefoperazone / sulbactam,piperacillin / tazobactam,imipenem. Conclusion Escherichia coli and Klebsiella pneumoniae are the main pathogenic bacteria causing community acquired pneumonia with children under 5 years old in Xiaogan area,the main rate of enzyme production accounts above for 53%,and average resistance rate was 59. 5%. Antibiotics should be chosen according to resistance analysis.

关 键 词：婴幼儿 社区获得性肺炎 细菌分布 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]