| 韩晗,郑绪阳,俞珍惜,金优萍,张卫英.2018-2020年我院儿科社区获得性肺炎病原菌分布及药敏分析[J].浙江中西医结合杂志,2021,31(2): |
| 2018-2020年我院儿科社区获得性肺炎病原菌分布及药敏分析 |
| Distribution of pathogenic bacteria and drug susceptibility analysis of community-acquired pediatric pneumonia in our hospital from 2018 to 2020 |
| 投稿时间：2020-05-26 修订日期：2020-08-13 |
| DOI： |
| 中文关键词: 社区获得性肺炎 病原菌 耐药性 痰培养 儿童 |
| 英文关键词:Community-acquired pneumonia Pathogenic bacteria Drug resistance Sputum culture children |
| 基金项目:2017年浙江省科技计划项目(项目批号：2017C37132) |
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| 中文摘要: |
| 目的 分析我院儿科社区获得性肺炎(CAP) 的病原菌分布及耐药情况,为临床医师合理应用抗菌药物治疗儿童CAP提供依据。方法 以2018年4月-2020年3月在我院儿科住院的CAP患儿2300例为研究对象, 取患儿痰标本送检痰细菌培养及药敏检测,并对结果进行分析总结。结果 送检痰培养标本中培养出阳性病原菌占23.61%(543/2300), 其中G- 菌309株(56.91%),G+ 菌197株(36.28%),G+菌和G- 菌混合感染者有37例(6.81%)。G- 菌排名前3 位致病菌分别是: 流感嗜血杆菌、大肠埃希菌、肺炎克雷伯菌。G- 菌对美洛培南、左氧氟沙星均高度敏感。流感嗜血杆菌对三代头孢的敏感性较高、其次是二代头孢及阿奇霉素；大肠埃希菌及肺炎克雷伯杆菌对哌拉西林他唑巴坦、头孢哌酮舒巴坦、头孢西丁的敏感性高于三代头孢。G+菌则以金黄色葡萄球菌和肺炎链球菌为主。金黄色葡萄球菌对头孢西丁、苯唑西林的敏感性相对较高,肺炎链球菌对头孢曲松的敏感性高于青霉素G,尚未发现对万古霉素、利奈唑胺耐药的G+菌。耐甲氧西林金黄色葡萄球菌( MRSA) 的检出率为21.5%(40/189),产超广谱β-内酰胺酶( ESBL) 的大肠埃希菌和肺炎克雷伯菌检出率分别为34.2%(13/38)和17.1%(6/35)。结论 CAP患儿痰培养检出的病原菌以革兰阴性菌为主,不同病原菌对常用抗菌药物的耐药性不同,临床医师可参考细菌药敏试验结果选用抗菌药物,以提高疗效,减少耐药菌株的产生。 |
| 英文摘要: |
| Objective To investigate the pathogenic bacteria and drug resistance of community acquired pneumonia (CAP) in children, and to provide reference for rational application of antimicrobial agents. Methods A total of 2300 CAP children hospitalized in our hospital from April 2018 to March 2020 were collected. Sputum samples were collected for sputum bacterial culture and drug sensitivity test. Results 23.61% (543/2300) of the sputum samples were positive for pathogenic bacteria, among which 309 strains of g-bacteria (56.91%), 197 strains of G+ bacteria (36.28%), and 37 cases (6.81%) were infected with mixed G+ bacteria and g-bacteria.The top 3 pathogenic bacteria of g-bacteria are: haemophilus influenzae, escherichia coli, klebsiella pneumoniae. G- bacteria are highly sensitive to meropenem and levofloxacin.The susceptibility of haemophilus influenzae to third-generation cephalosporins was higher in g-bacteria, but it was actually second-generation cephalosporins and azithromycin.The sensitivity of escherichia coli and klebsiella pneumoniae to piperacillin, tazobatam and cefoxetine was higher than that of the third generation cefetine. G+ bacteria were mainly staphylococcus aureus and streptococcus pneumoniae. Staphylococcus aureus has a relatively high sensitivity to cefoxitin and benzoxacillin, while streptococcus pneumoniae has a higher sensitivity to ceftriaxone than penicillin G, and no G+ bacteria resistant to vancomycin and linezolid have been found.The detection rate of methicillin-resistant staphylococcus aureus (MRSA) was 21.5%(40/189), and the detection rate of escherichia coli and klebsiella pneumoniae producing ESBLs was 34.2%(13/38)and 17.1%(6/35), respectively. Conclusion The pathogens detected in sputum culture of CAP children were mainly gram-negative bacteria, and different pathogenic bacteria have different resistance to common antibacterial drugs. In clinical practice, antimicrobial drugs can be selected according to the results of bacterial drug susceptibility test to improve the efficacy and reduce the emergence of drug-resistant strains. |
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