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

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。

Abstract:

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.