| 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 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。 |
| 关键词: 儿童 呼吸道感染 病原菌 耐药性 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2025.03.011 |
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| 基金项目:江苏省药学会-奥赛康医院药学基金科研项目,编号 A202111。 |
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| Distribution and Antimicrobial Resistance Analysis of Pathogens in Lower Respiratory Tract Infection in Children Under 14 Years Old |
| Cai Huihui, Zhang Li, Wang Yijun, Zhao Yanfeng |
| (The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China) |
| Abstract: |
| 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-spectrum β lactamases (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 of β lactamase 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 not detected. Conclusion: The main pathogens of lower respiratory tract infection in children are Gram negative bacteria, and the drug resistance of the main pathogens is severe, especially oxacillin-resistant S. aureus, penicillin-resistant S. pneumoniae and carbapename- resistant K. pneumoniae, which poses a serious threat to clinical anti-infection treatment. Pediatric clinical drug resistance monitoring and effective infection control measures should be strengthened. |
| Key words: children respiratory infection pathogens drug resistance |
