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| 1-3月龄重症社区获得性肺炎病原分布及细菌耐药性分析 |
| 陈明,孟庆清,张光莉,田小银,陈云秀,田永露,罗征秀 |
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| (重庆医科大学附属儿童医院,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,认知发育与学习障碍转化医学重庆市重点实验室,重庆 400014) |
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| 摘要: |
| 目的:分析重庆地区 1 ~3 月龄住院重症社区获得性肺炎(CAP)患儿病原检出情况及常见细菌耐药情况。 方法:回顾性分析 2014 年 1 月至 2015 年 12 月在重庆医科大学附属儿童医院呼吸病房住院治疗的 367 例 1 ~3 月龄重症 CAP 患儿的病原检出及常见细菌耐药情况。 结果:(1)367 例患儿深部痰液共培养出细菌 268 株,其中革兰阴性菌 209 株(占检出细菌的 78.0%),革兰阳性菌 59 株(22.0%),优势菌分别为肺炎克雷伯菌肺炎亚种、副流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌、沙眼衣原体、肺炎链球菌;(2)检出病毒 173 株,其中呼吸道合胞病毒 147 株(占检出病毒例数的 85.0%);(3)混合检出 118 株(32.2%),以细菌、病毒混合检出最常见;(4)细菌药物敏感试验分析发现:金黄色葡萄球菌对青霉素耐药率超过 90%,尚未发现对万古霉素耐药的金黄色葡萄球菌;肺炎链球菌对红霉素耐药率为100%,对青霉素耐药率低于 25%;大肠埃希菌对阿莫西林/克拉维酸等耐药率较低,而对头孢噻肟等耐药率超过70%;肺炎克雷伯菌对头孢类抗生素耐药率超过40%,对亚胺培南等耐药率低于10%;副流感嗜血杆菌对头孢噻肟敏感性较高,但对头孢克洛、头孢呋辛耐药率超过50%。 结论:重庆地区 1 ~3 月龄住院重症CAP 患儿检出病原中细菌占首位,主要为革兰阴性菌,临床需提高对沙眼衣原体肺炎的认识;呼吸道合胞病毒仍是最重要病毒病原;混合检出以细菌鄄病毒混合检出最常见;近年来通过对抗生素使用的严格控制,虽然细菌对有些抗生素的耐药率有所下降,但整体形势严峻,临床应加强细菌耐药情况的监测,并根据本地区重症肺炎的病原谱选择合适的抗生素。 |
| 关键词: 重症 社区获得性肺炎 病原 耐药分析 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2018.05.011 |
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| 基金项目:国家临床重点专科建设项目,编号 2011-873 |
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| Analysis of the Pathogens Distribution and Bacterial Resistance in 1 to 3 Months Old Infants with Severe Community Acquired Pneumonia |
| Chen Ming, Meng Qingqing, Zhang Guangli, Tian Xiaoyin, Chen Yunxiu, Tian Yonglu, Luo Zhengxiu |
| (Children's Hospital of Chongqing Medical University, Chongqing 400014, China) |
| Abstract: |
| Objective: To investigate the pathogens distribution and bacterial resistance in 1 to 3 months old infants with severe community acquired pneumonia (CAP) in Chongqing. Methods: The pathogens distribution and bacterial resistance in 1 to 3 months old infants with severe CAP in the ward of Children爷s Hospital of Chongqing Medical University between January 2014 and December 2015 were studied by retrospective analysis. Results: (1) A total of 268 strains were cultured from deep sputum of 367 cases, among which there were 209 strains of gram negative bacteria (78.0%), 59 strains of gram positive bacteria (22.0%), while Klebsiella pneumoniae pneumonia, Haemophilus parainfluenzae, Staphylococcus aureus, Escherichia coli, Chlamydia trachomatis, and Streptococcus pneumonia turned out to be the predominant bacteria. (2) Virus were identified in 173 strains, including 147(85.0%) strains of Respiratory syncytial virus (RSV). (3) Mixed-infections were found in 118 (32.2%) strains and mostly bacteria-virus co-infection. (4) Drug sensitive test showed that Staphylococcus aureus had more than 90% resistance rates to penicillin while it hadn't any resistance to vancomycin. Streptococcus pneumonia was 100% resistant to erythromycin and less than 25% to penicillin. Escherichia coli showed low resistance to amoxicillin/ clavulanic acid while more than 70% resistant to cefotaxime. Klebsiella pneumoniae had more than 40% and less than 10% resistance to cephalosporin antibiotics and thienamycin respectively. Haemophilus parainfluenzae showed rather high sensitivity to cefotaxime, except that more than 50% resisted to cefaclor and cefuroxime. Conclusion: The pathogens detected are mostly bacteria, especially gram negative bacilli, in 1 to 3 months old in-patients with severe CAP in Chongqing, more attention should be paid to Chlamydia trachomatis in clinical; RSV keeps the major type in virus infection. Mixed-infection is most commonly found as bacteria-virus co-infection. Although the resistant rates to some antibiotics have dropped down by restrict control of use over last years,
the overall resistance is still considerable. We suggest an enhanced surveillance over antibiotic administration and proper drug choices according to the antibiotic susceptibility profile. |
| Key words: severe community acquired pneumonia pathogen drug resistance analysis |
