我院不同年龄段儿童社区获得性大叶性肺炎病原学分析及细菌耐药性研究  

Pathogenic analysis and bacterial resistance of community-acquired lobar pneumonia in children of different ages in our hospital

作　　者：李容汉[1] 徐建锋[1] 李淑贤[1] LI Rong-han;XU Jian-feng;LI Shu-xian(Maternal and Child Health Hospital of Guangdong,Guangzhou,Guangdong 510010)

机构地区：[1]广东省妇幼保健院

出　　处：《赣南医学院学报》2019年第7期690-693,715,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨我院不同年龄段儿童社区获得性大叶性肺炎病原学分析及细菌耐药性研究,为临床抗感染方案的选择提供理论依据。方法:选取262例儿童社区获得性大叶性肺炎患儿,根据年龄段分组为A组(<3岁)58例,B组(3~6岁)108例,C组(>6岁)96例。分析3组患儿病原体的分布情况和主要病原菌的耐药性。结果:177例患儿病原体检测阳性,阳性率为67.56%。以单纯支原体感染最为常见,占43.51%。A组病原体以细菌为主,B组和C组病原体以支原体为主。肺炎链球菌为最常见病原菌,占43.24%,其次为肺炎克雷伯菌(16.22%),第三为大肠埃希菌(14.86%)。A组患儿细菌感染率最高,达到66.22%,B组为18.92%,C组为14.86%。肺炎链球菌对红霉素、克林霉素的耐药率达到75%以上,对阿莫西林/克拉维酸、头孢呋辛、头孢噻肟、头孢哌酮/舒巴坦、万古霉素敏感。肺炎克雷伯菌对氨苄西林的耐药率达到91.67%,对头孢曲松、头孢哌酮/舒巴坦、阿米卡星、亚胺培南敏感;大肠埃希菌对氨苄西林、头孢唑林、头孢呋辛、环丙沙星、左氧氟沙星的耐药率均超过60%,对头孢哌酮/舒巴坦、亚胺培南敏感。结论:我院儿童社区获得性大叶性肺炎可由病毒、支原体、细菌多种病原体感染而发病,且不同年龄段患儿病原体的构成存在一定差异。临床应根据病原体的类型及耐药情况选择合理的抗感染方案。Objective:To explore the pathogenic analysis and bacterial resistance study of community-acquired lobular pneumonia in children of different age groups in our hospital,and to provide theoretical basis for the selection of clinical anti-infection programs. Methods:A total of 262 children with community-acquired lobular pneumonia were selected,including 58 children in group A (< 3 years old),108 children in group B (3-6 years old),and 96 children in group C (> 6 years old).The distribution of pathogens and drug resistance of main pathogens in the three groups were analyzed. Results:177 cases were positive for pathogen,the positive rate was 67.56%.Mycoplasma only infection was the most common,accounting for 43.51%.The pathogens in group A are mainly bacteria,while the pathogens in group B and C are mainly mycoplasma.Streptococcus pneumoniae was the most common pathogen,accounting for 43.24%,followed by klebsiella pneumoniae (16.22%) and escherichia coli (14.86%).The bacterial infection rate of group A was the highest,reaching 66.22%,18.92% in group B and 14.86% in group C.Streptococcus pneumoniae was resistant to erythromycin and clindamycin by more than 75%,and was sensitive to amoxicillin/clavulanic acid,cefuroxime,cefotaxime,cefoperazone/sulbactan and vancomycin.The drug resistance rate of klebsiella pneumoniae to ampicillin reached 91.67%,and it was sensitive to ceftriaxone,cefoperazone/sulbactan,amikacin and imipenem.The drug resistance rate of escherichia coli to ampicillin,cefazolin,cefuroxime,ciprofloxacin and levofloxacin all exceeded 60%,and it was sensitive to cefoperazone/sulbactam and imipenem. Conclusions:Community-acquired lobular pneumonia in children in our hospital can be caused by various pathogens including virus,mycoplasma and bacteria,and the composition of pathogens in children of different ages is different.The reasonable anti-infection plan should be selected according to the type of pathogen and the situation of drug resistance.

关 键 词：儿童社区获得性大叶性肺炎 病原学 耐药性 

分 类 号：R563.11[医药卫生—呼吸系统]