多重耐药肺炎链球菌肺炎的危险因素及细菌耐药性分析  

Analysis of risk factors and bacterial drug resistance in children with pneumonia caused by multi-drug resistant Streptococcus pneumoniae

作　　者：王娴 甄冰红 罗晓琴 刘纯义[2] 

机构地区：[1]深圳市宝安区中心医院儿科,广东深圳518102 [2]深圳市宝安区妇幼保健院儿科,广东深圳518101

出　　处：《中国妇幼保健》2016年第23期5030-5032,共3页Maternal and Child Health Care of China

基　　金：深圳市宝安区科技创新局科研基金资助项目(2014149)

摘　　要：目的探讨多重耐药肺炎链球菌肺炎的危险因素以及该菌对常用抗菌药物的耐药情况,为防止和减少多重耐药肺炎链球菌肺炎的发生以及合理使用抗生素提供参考依据。方法选择该院儿科及深圳市宝安区妇幼保健院儿科72例多重耐药肺炎链球菌肺炎患儿作为病例组,另选择同期该院儿科及深圳市宝安区妇幼保健院儿科63例非多重耐药肺炎链球菌肺炎患儿作为对照组,采用病例对照研究,对两组患儿不合理使用抗生素、住院时间、是否气管插管机械通气、机械通气时间、基础疾病共5个危险因素进行比较,并对72株多重耐药肺炎链球菌的药物敏感性进行分析。结果两组患儿在不合理使用抗生素、住院时间、是否气管插管机械通气、机械通气时间、基础疾病方面比较,差异均具有统计学意义(P<0.05);多重耐药肺炎链球菌对青霉素类、头孢菌素类、大环内酯类以及喹诺酮类抗生素均有较高的耐药率,而对糖肽类抗生素仍保持较高的敏感率。结论不合理使用抗生素、住院时间长、气管插管机械通气、机械通气时间长、原有基础疾病是多重耐药肺炎链球菌肺炎的重要危险因素;多重耐药肺炎链球菌对青霉素类、头孢菌素类、大环内酯类以及喹诺酮类抗生素均有较高的耐药性,但对糖肽类抗生素仍有较高的敏感性;合理使用抗生素、尽量缩短住院时间、严格掌握气管插管机械通气指征而尽量减少不必要的气管插管机械通气、缩短机械通气时间、治疗原有基础疾病是防止多重耐药肺炎链球菌肺炎的关键;糖肽类抗生素(万古霉素)可以作为治疗多重耐药肺炎链球菌肺炎的首选抗菌药物。Objective To explore the risk factors of pneumonia caused by multi-drug resistant Streptococcus pneumoniae and drug resistance, provide reference basis for preventing and controlling the prevalence of pneumonia caused by multi-drug resistant Streptococcus pneumoni- ae and rational use of antibiotics. Methods Seventy-two children with pneumonia caused by multi-drug resistant Streptococcus pneumoniae were selected from Department of Pediatrics in the hospital as case group; 63 children with pneumonia caused by non-multi-drug resistant Streptococcus pneumoniae were selected from Department of Pediatrics in the hospital during the same period as control group. A case-control study was conducted to compare five risk factors （irrational use of antibiotics, hospitalization time, mechanical ventilation or not, mechanical ventilation time, and basic diseases） between the two groups. Drug sensitivity test was performed among 72 multi-drug resistant Streptococcus pneumoniae strains. Results There were statistically significant differences in irrational use of antibiotics, hospitalization time, mechanical ventilation or not, mechanical ventilation time, and basic diseases between the two groups （P〈0. 05） ; the drug resistance rates of multi-drug resistant Streptococcus pneumoniae to peuicillins, eephalosporins, aminoglycosides, and quinolones were high, but the sensitivity to glycopeptide antibiotics was relatively high. Conclusion Irrational use of antibiotics, hospitalization time, mechanical ventilation, mechanical ventilation time, and basic diseases are important risk factors of pneumonia caused by multi-drug resistant Streptococcus pneumoniae; the drug resistance rates of multi-drug resistant Streptococcus pneumoniae to penicillins, cephalosporins, aminoglycosides, and quinolones are high, but the sensitivity to glycopeptide antibiotics is relatively high; rationally using antibiotics, shortening hospitalization time, grasping the indications of mechanical ventilation, reducing unnecessary mechanical ventilat

关 键 词：多重耐药 肺炎链球菌 肺炎 危险因素 

分 类 号：R378.1[医药卫生—病原生物学]