学龄前儿童急性呼吸道感染鼻咽部菌谱分析  

Study on nasopharyngeal pathogenic bacterial spectrum in preschool children with acute respiratory infections

作　　者：陈恒 江立千 李亚东 柯茂彬 

机构地区：[1]广东同江医院检验科,广东顺德528300 [2]广东大良医院检验科,广东顺德528300

出　　处：《检验医学与临床》2015年第21期3175-3176,3181,共3页Laboratory Medicine and Clinic

基　　金：广东省佛山市科技局医学类科技攻关立项课题(2014AB001523)

摘　　要：目的了解顺德地区学龄前儿童急性呼吸道感染(ARI)鼻咽部细菌分布及耐药状况,以指导临床诊疗。方法选择2013年10月至2014年12月医院住院治疗的学龄前ARI患儿1 003例,其中急性上呼吸道感染302例,支气管炎126例,肺炎575例。采集咽拭子,进行菌种鉴定、药敏试验和统计学分析。结果 (1)该地区儿童ARI以春季好发;住院患儿肺炎感染占57.3%。(2)1 003份咽拭子分离菌株213株,阳性率为21.2%,其中革兰阴性菌和革兰阳性菌分别占53.1%、42.3%,假丝酵母菌占4.2%。(3)患儿鼻咽部病原菌检测的阳性率随着年龄的增长而降低;各年龄组检出菌谱有所差异,但均以金黄色葡萄球菌(SA)检出为首。(4)SA 100%产β-内酰胺酶,MRSA占28.8%;产ESBL的大肠埃希菌和肺炎克雷伯菌为15.4%、25.0%。结论监测期间该地区主要流行菌株是SA;学龄前儿童ARI各年龄段的细菌种类和阳性率不尽相同,临床选择抗菌药物时,应加强监测,综合考虑各种因素。Objective To understand the nasopharyngeal pathogenic bacteria distribution and antibiotic resistance situation in the preschool children with acute respiratory infections（ARI）in order to guide clinical diagnosis and treatment.Methods A total of 1 003pre-school children inpatients with ARI from Oct.2013 to Dec.2014 were selected,including of 302 cases of ARI,126 cases of bronchitis and 575 cases of pneumonia.The nasopharyngeal swab was collected for conducting the pathogenic bacterialidentification and antibiotic susceptibility test.The results were statistically analyzed.Results（1）Children with ARI were used to appear mostly in spring in this area;children inpatients with pneumonia accounted for 57.3%.（2）A total of 213 strains of bacteria were isolated from 1 003 pharyngeal swabs,the positive rate was 21.2%.The proportions of Gram negative bacilli,Gram positive cocci and Candida were 53.1%,42.3% and 4.2% respectively.（3）With the increase of age,the positive rate of nasopharyngeal pathogen detection was significantly reduced;the bacterial spectrum detected in various age groups of ARI was different,and the detection rate of Staphylococcus aureus（SA）was highest.（4）100% of SA yieldedβ-lactamase,in which MRSA accounted for 28.8%;E.coli and K.pneumoniae producing extended spectrum beta-lactamase（ESBL）were 15.4% and25.0% respectively.Conclusion SA is the most predominant pathogenic strain;the bacterial species and positive rate in different age groups of pre-school children ARI are not the same.Selecting antibacterial drugs in clinic should strengthen monitoring and comprehensively consider various factors.

关 键 词：急性呼吸道感染 儿童 病原菌 抗菌药物 

分 类 号：R725.6[医药卫生—儿科]