361例儿童院内获得性肺炎的细菌学检测和耐药性分析  

Bacteriological Detection and Drug Resistance Analysis of 361 Cases of Hospital Acquired Pneumonia in Children

作　　者：尹奎夫[1] 李树青[1] 沈玲[1] 吴春莲[1] 

机构地区：[1]潍坊市妇幼保健院儿科,山东潍坊261011

出　　处：《潍坊医学院学报》2017年第4期299-301,共3页Acta Academiae Medicinae Weifang

摘　　要：目的了解本地区院内获得性肺炎(HAP)的病原学特点及常见细菌的耐药状况。方法将2006年12月~2016年12月期间住院的符合小儿HAP标准的361例患儿作为研究对象,在患儿入院或确诊HAP当天按要求留取痰液标本,按《全国临床检验操作规程》培养分离菌种,采用纸片扩散法进行药物敏感试验。结果 361例共获得阳性标本277例,阳性率为76.73%,共培养出细菌285株,其中G^+球菌75株(26.31%),G^-杆菌210株(73.68%),其中G^-杆菌主要为:肺炎克雷伯菌、大肠埃希菌、铜绿假单孢菌和鲍氏不动菌,共153株(72.85%)(153/210),G^+球菌主要为金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌。G^+球菌对万古霉素尚无耐药菌株,对头孢曲松钠耐药率较低,对其他常用抗生素耐药率较高。肺炎克雷伯菌和大肠杆菌耐药率较低的药物有环丙沙星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦(10.5%~19.5%),鲍氏不动菌对各种抗生素的耐药率较高。结论本地区HAP病原菌以G^-杆菌为主,常见细菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单孢菌和金黄色葡萄球菌,对常用抗生素耐药率高。Objective To understand the regional etiological characteristics and drug resistance of the common bacteria about hospital acquired pneumonia（ HAP）. Methods The research objects were 361 cases of children acquired pneumonia during the treatment in department of pediatrics from December 2006 to December 2016. Children＇s sputum specimens were taken when they were admitted to hospital or confirmed of HAP. It cultured and separated the strains on the basis of National Clinical Laboratory Procedures. It used disk diffusion method to conduct drug sensitivity tests. Results In the 361 cases,the samples of 277 cases were positive. The positive rate was 76. 73%. A total of 285 bacteria strains were cultivated,in which the strains of G^＋cocci were 75,accounting for 26. 31%,and the strains of G--bacilli were210,accounting for 73. 68%. The main G--bacilli were klebsiella pneumoniae,escherichia coli,pseudomonas aeruginosa and acinetobacter baumannii,a total of 153 strains,accounting for 72. 85%（ 153/210）. The main G^＋cocci were staphylococcus aureus,staphylococcus epidermidis and streptococcus pneumoniae. There were no strains of G^＋cocci resistant to vancomycin. The resistant rate of G^＋cocci to ceftriaxone was low,but to other commonly used antibiotic was higher. Klebsiella pneumoniae and escherichia coli had lower resistance to ciprofloxacin,piperacillin/tazobactam and cefoperazone/sulbactam（ 10. 5% - 19. 5%）. Acinetobacter baumanniifor had higher resistance to various kinds of antibiotics. Conclusion G--bacilli are the main pathogenic bacteria in HAP,and the common bacteria are klebsiella pneumoniae,escherichia coli,pseudomonas aeruginosa and staphylococcus aureus. They have high resistance to commonly used antibiotics.

关 键 词：院内获得性肺炎 病原菌 儿童 

分 类 号：R563.1[医药卫生—呼吸系统]