小儿下呼吸道感染常见病原体分布及耐药性

Distribution and antimicrobial resistance of common pathogens in children with lower respiratory tract infection

摘要:

目的了解小儿急性下呼吸道感染常见病原体分布及耐药情况，为临床合理应用抗菌药物提供依据。方法采用法国生物梅里埃VITEK2compact鉴定及药敏仪，对某院2012年全年住院的下呼吸道感染患儿痰培养所分离的菌株进行鉴定，并对主要菌种做药敏试验。结果 1 080份标本共分离病原体314株（29.07%），其中革兰阴性（G-）杆菌224 株（71.34%），主要为大肠埃希菌（56株）、肺炎克雷伯菌(49株)、阴沟肠杆菌（46株）、黏质沙雷菌（39株）；革兰阳性（G+）菌85株（27.07%），主要为金黄色葡萄球菌（30株，其中耐甲氧西林株8株）、溶血葡萄球菌（26株）、表皮葡萄球菌（16株，其中耐甲氧西林株6株）；真菌5株（1.59%），均为白假丝酵母菌。G-杆菌对亚胺培南和美罗培南敏感率为100.00%，对常用的头孢菌素类抗生素表现出广谱耐药；G+菌对万古霉素敏感率为100.00%，对利奈唑胺高度敏感。结论小儿下呼吸道感染存在多重耐药菌感染，临床医生应密切关注检出菌的耐药机制，根据药敏结果合理使用抗菌药物，尽量减少新的耐药菌产生。

关键词:

儿童; 呼吸道感染; 肺炎; 病原体; 抗药性,微生物; 合理用药; 耐药

Abstract:

ObjectiveTo realize the distribution and antimicrobial resistance of common pathogens in children with lower respiratory tract infection (LRTI), and provide basis for rational use of antimicrobial agents.MethodsPathogens were isolated from sputum of hospitalized children with LRTI in 2012, identification and antimicrobial susceptibility testing of major pathogens were performed with VITEK2compact system.ResultsOf 1 080 sputum specimens, 314(29.07%) isolates of pathogens were detected, 224(71.34%) of which were gramnegative bacilli, the major were Escherichia coli (n=56),Klebsiella pneumoniae (n=49), Enterobacter cloacae（n=46）,Serratia marcescens（n=39）; grampositive bacteria were 85 isolates (27.07%), the major were Staphylococcus aureus (n=30,8 were methicillinresistant strains), Staphylococcus haemolyticus (n=26), and Staphylococcus epidermidis (n=16, 6 were methicillinresistant strains); fungi were 5 isolates(1.59%), all were Candida albicans. Gramnegative bacilli were sensitive to imipenem and meropenem,sensitive rate was 100.00%, but had broadspectrum cephalosporin resistance; grampositive bacteria had 100.00% sensitive rate to vancomycin and was highly sensitive to linezolid. ConclusionMultidrugresistant organisms exists in LRTI in children, clinicians should pay attention to the resistance mechanisms of pathogens,use antimicrobial agents according to antimicrobial susceptibility testing results.

Key words:

child; respiratory tract infection; pneumonia; pathogen; drug resistance, microbial; rational drug use; drugresistance