重症肺炎患儿315例细菌病原学及耐药性分析  

Bacterial etiology and drug resistance in 315 children with severe pneumonia

作　　者：王惠霞 武万良 王维娟 成钧 WANG Hui-xia;WU Wan-liang;WANG Wei-juan;CHENG Jun(Pediatric Intensive Care Unit, Northwest Women and Children＇s Hospital, Shaanxi Xi ＇ an 710061, China)

机构地区：[1]西北妇女儿童医院儿童重症监护室,陕西西安710061

出　　处：《中国妇幼健康研究》2018年第4期474-476,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨重症肺炎患儿细菌病原学及其耐药性情况。方法选取2015年6月至2017年5月西北妇女儿童医院呼吸内科及儿童重症监护室(PICU)收治的315例重症肺炎患儿的痰培养结果及其药物敏感试验结果进行回顾性分析。结果在315例患儿中,检出明确病原菌205株,其中革兰阴性菌147株(71.71%),革兰阳性球菌46株(22.44%)。检出率位于前5位的病原菌分别为:大肠埃希菌56株(27.32%),肺炎克雷伯菌38株(18.54%),铜绿假单胞菌19株(9.27%),肺炎链球菌18株(8.78%),金黄色葡萄球菌15例(7.32%)。药物耐药性分析显示:革兰阴性杆菌对常用二、三代头孢菌素耐药率较高(最低19.80%),对哌拉西林/他唑巴坦、亚胺培南/西司他丁、环丙沙星、左氧氟沙星的耐药率较低(最低16.21%);革兰阳性球菌对青霉素G、苯唑西林、红霉素耐药率较高(最低60.7%),对万古霉素、利奈唑胺敏感度无耐药性。结论婴幼儿重症肺炎主要由细菌感染引起,以革兰阴性杆菌为主,对常用二、三代头孢类抗生素耐药率高,哌拉西林/他唑巴坦及碳青霉烯类抗生素可作为经验首选用药。Objective To investigate the bacterial etiology and drug resistance in children with severe pneumonia. Methods The sputum culture results and drug sensitivity test results of 315 children with severe pneumonia admitted to the Department of Respiratory Medicine and Pediatric Intensive Care Unit （PICU） of Northwest Women and Children＇s Hospital during June 2015 to May 2017 were selected and retrospectively analyzed. Results Among 315 children, 205 stains of pathogenic bacteria were identified, including 147 gram-negative bacteria （71.71%） and 46 gram-positive cocci （22.44 %）. The top five pathogenic bacteria were escherichia coli （56, 37.32%）, klebsiella pneumoniae （38, 18.54%）, pseudomonas aeruginosa （19, 9.27%）, streptococcus pneumoniae （18, 8.78%）, and staphylococcus aureus （15, 7.32%）. Drug resistance analysis showed that gram-negative bacilli were of a higher resistance rate to commonly used second and third-generation cephalosporins （minimum of 19.80%）. And the gram-negative bacilli were of lower resistance to piperacillin/tazobactam, imipenem/cilastatin, ciprofloxacin, and levofloxacin （minimum of 16.21 %）. Conversely, gram-positive cocci were of a higher resistance rate to penicillin G, oxacillin and erythromycin （minimum of 60.7 % ）, while they were not resistant to vancomycin or linezolid. Conclusion Severe pneumonia in infants and young children is mainly caused by bacterial infections. And the gram-negative bacilli are the main pathogens, which are of a high resistance rate to commonly used second- and third-generation cephalosporins. Therefore, piperacillin/tazobactam and carbapenem antibiotics can be used as the first choice for experience.

关 键 词：重症肺炎 微生物敏感性试验 病原学 耐药率 

分 类 号：R725.6[医药卫生—儿科]