苏州地区近10年儿童呼吸道铜绿假单胞菌感染流行病学特点及耐药性分析  

Epidemiological characteristics and drug resistance analysis of Pseudomonas aeruginosa infection in respiratory tract of children in Suzhou area in recent 10 years

作　　者：武银银 顾文婧[2] 陈正荣[2] 张利亚[1] 季伟[2] Wu Yinyin;Gu Wenjing;Chen Zhengrong;Zhang Liya;Ji Wei(Department of General Medicine,Children′s Hospital Affiliated to Soochow University,Suzhou 215003,Jiangsu Province,China;Department of Respiratory,Children′s Hospital Affiliated to Soochow University,Suzhou 215003,Jiangsu Pro-vince,China)

机构地区：[1]苏州大学附属儿童医院综合内科,江苏苏州215003 [2]苏州大学附属儿童医院呼吸科,江苏苏州215003

出　　处：《中华实用儿科临床杂志》2020年第18期1407-1410,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81570016,81401296)。

摘　　要：目的分析苏州地区儿童呼吸道铜绿假单胞菌(PA)感染流行病学特点及药敏变迁情况,以期对本地区临床合理使用抗生素提供指导建议。方法收集2008年1月至2017年12月21176例因呼吸道感染入住苏州大学附属儿童医院呼吸科患儿鼻咽分泌物标本的细菌培养结果,根据年龄、季节、基础疾病情况及本次入院期间有无重症监护室(ICU)入住史进行分组,监测PA感染流行特点并动态观察PA药敏变迁情况。结果21176份呼吸道感染患儿的鼻咽分泌物标本中,191份培养出PA,阳性检出率为0.90%(191/21176份)。年检出率不同,以2009年最高[2.24%(50/2234份)],2014年最低[0.41%(9/2207份)];PA检出率以>6个月~1岁组检出率最高[1.52%(53/3497份)],>5岁组最低[0.57%(11/1934份)]。春、夏、秋、冬各季节PA检出率依次为1.11%(60/5420份)、1.21%(61/5046份)、0.81%(46/5670份)、0.48%(24/5040份),夏季最高,冬季最低,差异有统计学意义(χ2=18.611,P<0.001)。21176例患儿中有基础疾病者占18.89%(4000/21176例),有基础疾病组PA检出率为1.28%(51/4000份),高于无基础疾病组[0.82%(140/17176份)];ICU组PA检出率为4.41%(15/340份),高于普通组[0.84%(176/20836份)],差异均有统计学意义(χ2=7.678、47.623,均P<0.05)。未检出对氨苄西林、氨苄西林舒巴坦、复方磺胺甲唑敏感菌株;2010年至2017年未检出对头孢曲松敏感菌株;对亚胺培南药敏试验敏感率在2012年至2015年较低,最低为2014年(仅66.7%);对氨曲南药敏试验敏感率各年间波动明显;对哌拉西林、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星、庆大霉素、妥布霉素均高度敏感。结论PA感染易发生在有基础疾病、病情相对较重的小年龄儿童,夏季为高发季节,PA对常用抗生素耐药性普遍较高。Objective The epidemiological characteristics and drug susceptibility changes of Pseudomonas aeruginosa(PA) infection in the respiratory tract of children in suzhou were analyzed in order to provide guidance and suggestions for the rational use of antibiotics in this region.Methods Bacterial culture results of nasopharyngeal secretions from 21 176 children admitted to the Department of Respiratory, Children′s Hospital Affiliated to Soochow University for respiratory tract infections from January 2008 to December 2017 were collected.According to age, season, underlying disease conditions and the presence of intensive care units (ICU) during the hospitalization, these children were divided into different groups.The epidemic characteristics of PA infection were monitored, and changes in PA drug sensitivity were dynamically observed.Results Among 21 176 nasopharyngeal secretions from children with respiratory tract infection, 191 cultures were detected with PA, and showing a positive detection rate of 0.90% (191/21 176 cases). The annual detection rate was different.The highest detection rate was 2.24% (50/2 234 cases) in 2009 and the lowest was 0.41% (9/2 207 cases) in 2014.The detection rate of PA in children with in >6 months to 1-year-old group was the highest (1.52%, 53/3 497 cases), and the lowest was 0.57%(11/1 934 cases) in the >5-year-old group.The detection rates of PA in spring, summer, autumn, and winter were 1.11% (60/5 420 cases), 1.21% (61/5 046 cases), 0.81% (46/5 670 cases), and 0.48% (24/5 040 cases), respectively.The difference of PA detection rates between summer (the highest rate) and the winter (the lowest rate) was statistically significant (χ2=18.611, P<0.001). Among the 21 176 children, 18.89% (4 000/21 176 cases) had basic diseases, and the PA detection rate in such kind of patients was 1.28% (51/4 000 cases), which was higher than that in patients without basic diseases (0.82%, 140/17 176 cases). The PA detection rate in the ICU group was 4.41% (15/340 cases), which was significantly hig

关 键 词：铜绿假单胞菌 儿童 呼吸道 

分 类 号：R446.5[医药卫生—诊断学] R725.6[医药卫生—临床医学]