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目的调查温州育英儿童医院小儿下呼吸道感染的病原菌及其耐药性。方法对2003-01—2004-12温州医学院附属育英儿童医院呼吸病区1763例下呼吸道感染患儿的痰液标本经分离培养,做菌株鉴定和药敏试验。结果共分离培养出病原菌715株,总阳性率为40·6%。其中革兰阴性菌448株,占62·7%;革兰阳性菌148株,占20·7%;真菌119株,占16·6%。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌为主。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)的百分率分别为49·3%和46·5%,较敏感的抗生素为亚胺培南、丁胺卡那霉素、环丙沙星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦;除铜绿假单胞菌对复方新诺明的耐药率为100%外,铜绿假单胞菌和鲍曼不动杆菌对各种抗生素的耐药性均较低。革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主。肺炎链球菌对青霉素的耐药率达到71·1%,对环丙沙星和万古霉素敏感,耐药率为0。金黄色葡萄球菌中耐甲氧西林金葡菌(MRSA)占18·0%(9/50),对环丙沙星、左旋氧氟沙星和万古霉素敏感。结论温州地区小儿下呼吸道感染的病原菌以革兰阴性菌为主,肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎链球菌、金黄色葡萄球菌为主要病原菌。对抗生素的耐药性较强,临床上应注意对这些菌株的检测,积极防治。
Objective To investigate the pathogens and drug resistance of children’s lower respiratory tract infection in Wenzhou Yuying Children’s Hospital. Methods From January 2003 to December 2004, sputum samples from 1763 children with lower respiratory tract infection in the Respiratory Diseases of Yuying Children’s Hospital Affiliated to Wenzhou Medical College were isolated and identified, and the strains were identified and tested for susceptibility. Results A total of 715 pathogens were isolated and cultured, the total positive rate was 40.6%. Among them, 448 were Gram-negative bacteria, accounting for 62.7%; 148 were Gram-positive bacteria, accounting for 20.7%; and 119 were fungi, accounting for 16.6%. Gram-negative bacteria Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii-based. The percentages of ESBLs producing Klebsiella pneumoniae and Escherichia coli were 49.3% and 46.5% respectively. The more sensitive antibiotics were imipenem, amikacin Ciprofloxacin, Piperacillin / Tazobactam and Cefoperazone / Sulbactam; except for P. aeruginosa, the resistance rate to cotrimoxazole was 100%, Pseudomonas aeruginosa Acinetobacter baumannii and a variety of antibiotic resistance are low. Gram-positive bacteria in Streptococcus pneumoniae and Staphylococcus aureus-based. Streptococcus pneumoniae penicillin resistance rate reached 71.1%, ciprofloxacin and vancomycin sensitive rate of 0. Staphylococcus aureus methicillin-resistant Staphylococcus aureus (MRSA) accounted for 18.0% (9/50), ciprofloxacin, levofloxacin and vancomycin-sensitive. Conclusion The pathogens of lower respiratory tract infection in children in Wenzhou are mainly Gram-negative bacteria, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, Streptococcus pneumoniae and Staphylococcus aureus Pathogen. Strong resistance to antibiotics, clinically should pay attention to the detection of these strains, and active prevention and treatment.