14岁以下儿童下呼吸道感染病原菌分布和耐药性分析  

Distribution and Antimicrobial Resistance Analysis of Pathogens in Lower Respiratory Tract Infection in Children Under 14 Years Old

作　　者：蔡惠惠[1] 张莉[1] 王义俊[1] 赵艳丰[1] Cai Huihui;Zhang Li;Wang Yijun;Zhao Yanfeng(The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院,南京210011

出　　处：《儿科药学杂志》2025年第3期44-48,共5页Journal of Pediatric Pharmacy

基　　金：江苏省药学会-奥赛康医院药学基金科研项目,编号A202111。

摘　　要：目的:分析儿童下呼吸道感染病原菌的分布特征及耐药性,为临床经验性诊治提供参考。方法:回顾性分析2021-2023年南京医科大学第二附属医院收治的<14岁患儿下呼吸道感染的病原菌分布及季节变化规律,对重点细菌的药敏试验结果进行分析。结果:共检出病原菌711株,其中革兰阳性菌329株,占比46.3%;革兰阴性菌380株,占比53.5%;真菌2株,占比0.3%。检出率排名前5位的细菌依次为大肠埃希菌(121株)、金黄色葡萄球菌(114株)、肺炎链球菌(87株)、流感嗜血杆菌(83株)、肺炎克雷伯菌(48株)。季节分布以春季检出率最高,其次为冬季。婴儿期和幼儿期是前5位病原菌检出率最高的年龄阶段。大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBLs)表型检出率分别为48.3%和25.8%。药敏试验结果显示,大肠埃希菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星、头孢吡肟、头孢替坦的敏感率较高(>95%),肺炎克雷伯菌对氨基糖苷类、四环素类和复方磺胺甲噁唑敏感率较高,多在90%以上,但对碳青霉烯类耐药率在21.6%~27.3%。流感嗜血杆菌β内酰胺酶阳性率为54.7%,对氨苄西林耐药率为93.0%。金黄色葡萄球菌对青霉素、红霉素耐药率较高,分别是91.2%、52.7%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为37.7%。肺炎链球菌对红霉素100%耐药,对四环素的耐药率达84.7%,未检出对万古霉素和利奈唑胺耐药的金黄色葡萄球菌和肺炎链球菌。结论:儿童下呼吸道感染的主要病原菌以革兰阴性菌更多见,主要病原菌的耐药现象严峻,尤其是苯唑西林耐药的金黄色葡萄球菌、青霉素耐药的肺炎链球菌、碳青霉烯类耐药的肺炎克雷伯菌,对临床抗感染治疗构成严重的威胁,需加强儿科临床耐药监测和及时采取有效控制感染的措施。Objective:To analyze the distribution and antimicrobial resistance of pathogens in children with lower respiratory tract infection,so as to provide reference for clinical empirical diagnosis and treatment.Methods:The pathogenic bacteria distribution and seasonal variation of lower respiratory tract infection in children under 14 years old admitted into the Second Affiliated Hospital of Nanjing Medical University from 2021 to 2023 were retrospectively analyzed,and the drug susceptibility test results of key bacteria were analyzed.Results:A total of 711 strains were detected,among which 329 cases were Gram positive,accounting for 46.3%;380 cases were Gram negative strains,accounting for 53.5%;2 strains were fungi,accounting for 0.3%.The top five bacteria in terms of isolation rates were respectively Escherichia coli(121 strains),Staphylococcus aureus(114 strains),Streptococcus pneumoniae(87 strains),Haemophilus influenzae(83 strains),and Klebsiella pneumoniae(48 strains).The seasonal distribution showed the highest detection rate in spring,followed by winter.Infant and early childhood were the age stages with the highest detection rate of the top five pathogens.The phenotypic detection rates of extended-spectrumβlactamases(ESBLs)in E.coli and K.pneumoniae were 48.3%and 25.8%,respectively.According to the results of drug sensitivity,E.coli were highly sensitive to imipenem,piperacillin/tazobactam,amikacin,cefepime and cefotetan(>95%).K.pneumoniae had a high sensitivity rate to aminoglycosides,tetracyclines,and cotrimoxazole,mostly above 90%,yet the resistance rate to carbapenems was from 21.6%to 27.3%.The positive rate ofβlactamase in H.influenzae was 54.7%,and the resistance rate to ampicillin was 93.0%.The resistance rate of S.aureus to penicillin and erythromycin was 91.2%and 52.7%,respectively.The detection rate of methicillin-resistant S.aureus(MRSA)was 37.7%.S.pneumoniae was 100%resistant to erythromycin and 84.7%resistant to tetracycline.S.aureus and S.pneumoniae resistant to vancomycin and linezolid were n

关 键 词：儿童 呼吸道感染 病原菌 耐药性 

分 类 号：R725.6[医药卫生—儿科]