2018—2022年某地市级儿童医院小儿肺炎患者分离苛养菌分布及耐药性  

Distribution and antimicrobial resistance of fastidious bacteria isolated from children with pneumonia in a city-level children’s hospital from 2018 to 2022

作　　者：黄轲琳[1] 陈亮[1] 袁红霞[2] 陈虹亮[1] 欧阳育琪[1] HUANG Ke-lin;CHEN Liang;YUAN Hong-xia;CHEN Hong-liang;OUYANG Yu-qi(Department of Infection Control,Chenzhou No.1 People’s Hospital,Chenzhou 423000,China;Department of Laboratory Medicine,Chenzhou No.1 People’s Hospital,Chenzhou 423000,China)

机构地区：[1]郴州市第一人民医院感控科,湖南郴州423000 [2]郴州市第一人民医院检验科,湖南郴州423000

出　　处：《中国感染控制杂志》2023年第9期1101-1106,共6页Chinese Journal of Infection Control

基　　金：南华大学医院管理研究所项目(2021YJGL10)。

摘　　要：目的 调查某儿童专科医院苛养菌分布及对抗菌药物的耐药性特点,为儿科医生合理使用抗菌药物提供参考依据。方法 通过连续性监测分析某院2018—2022年呼吸道标本分离的主要苛养菌种及其耐药性。结果 分离株数居前三位的苛养菌是:肺炎链球菌(Spn)、流感嗜血杆菌(Hi)、卡他莫拉菌(Mc)。Spn对红霉素、克林霉素、四环素、头孢呋辛的平均耐药率高(均>75%),对青霉素、头孢曲松、阿莫西林/克拉维酸的平均耐药率低(均<15%);Hi对氨苄西林的平均耐药率较高(接近75%),对头孢噻肟、头孢呋辛、头孢克洛、阿莫西林/克拉维酸的耐药率较低(<45%);Mc对氨苄西林平均耐药率高(>90%),对其余常用抗菌药物平均耐药率均低(<30%)。三种细菌5年间对上述药物的耐药率比较,差异均有统计学意义(均P<0.05)。结论 考虑小儿使用抗菌药物的特殊性并结合本研究结果,Spn可先经验性使用青霉素类、第三代头孢类、β-内酰胺酶类药物,Hi可先经验性使用第二、三代头孢类、β-内酰胺类药物,Mc可经验性使用除氨苄西林外的抗菌药物,再根据病原学结果及药敏结果回报调整用药方案。Objective To investigate the distribution and antimicrobial resistance characteristics of fastidious bacteria in a children’s hospital,and provide reference for pediatricians to use antimicrobial agents rationally.Methods Main species and antimicrobial resistance of fastidious bacteria from respiratory specimens in a hospital from 2018 to 2022 were analyzed through continuous monitoring.Results The top three isolated fastidious bacteria were Streptococcus pneumoniae(Spn),Haemophilus influenzae(Hi),and Moraxella catarrhalis(Mc).The average resis-tance rate of Spn to erythromycin,clindamycin,tetracycline and cefuroxime was high(>75%),while to penicillin,ceftriaxone,and amoxicillin/clavulanic acid was low(<15%).The average resistance rate of Hi to ampicillin was high(close to 75%),to cefotaxime,cefuroxime,cefaclor and amoxicillin/clavulanic acid was low(<45%).The average resistance rate of Mc to ampicillin was high(>90%),to the remaining frequently used antimicrobial agents was low(<30%).The resistance rates of the three types of bacteria to the above mentioned antimicrobial agents over the past 5 years showed statistically significant differences(all P<0.05).Conclusion Considering the particularity of antimicrobial use in children,and combined with the results of this study,for Spn infections,empirical treatment may be initiated with penicillin,third-generation cephalosporins,or beta-lactamase inhibitors;for Hi infections,empirical treatment may involve second-and third-generation cephalosporins or beta-lactam antibiotics;for Mc infections,empirical treatment can use antimicrobial agents other than ampicillin.Subsequently,the treatment regimen should be adjusted based on the pathogen and drug sensitivity results.

关 键 词：儿童医院 肺炎 苛养菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]