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目的:了解婴幼儿社区获得性肺炎(CAP)产超广谱β-内酰胺酶(ESBLs)菌的分布及耐药情况。方法:选取2013年1-12月我院收治的婴幼儿CAP患儿2 526例,取痰标本送细菌培养,药敏试验采用琼脂扩散敏感试验(K-B法)。结果:2 526例患儿中痰培养检出产ESBLs菌173株(检出率6.85%),其中大肠埃希菌89株、肺炎克雷伯菌56株、阴沟肠杆菌14株、产气肠杆菌10株、铜绿假单胞菌4株(产酶率分别为55.3%、56.6%、41.2%、29.4%、18.2%);产ESBLs菌的检出率在3个月内的小婴儿明显高于3个月以上患儿(P均<0.01);产ESBLs菌对氨苄西林、头孢唑林、头孢呋辛、头孢噻肟高度耐药(耐药率85.55%~100%),对头孢他啶、头孢吡肟、氨曲南中度耐药(耐药率43.35%~58.38%),对头孢西丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南敏感;产ESBLs菌的耐药率明显高于非产ESBLs菌(P<0.01)。结论:婴幼儿CAP产ESBLs菌以大肠埃希菌、肺炎克雷伯菌为主,其检出率与年龄密切相关,3个月内的小婴儿感染率高,对临床常用青霉素类、头孢菌素类抗生素大部分耐药,对头霉素类及酶抑制剂复合制剂大部分敏感,对碳青霉烯类抗生素完全敏感。
Objective: To understand the distribution and drug resistance of extended-spectrum β-lactamases (ESBLs) producing community-acquired pneumonia (CAP) in infants and young children. Methods: Totally 2 526 infants with CAP in our hospital from January to December in 2013 were selected and sputum samples were taken for bacterial culture. The susceptibility test was performed by agar diffusion sensitivity test (K-B method). Results: Totally 173 ESBLs producing strains were detected in sputum cultures of 5226 children (detection rate was 6.85%), including 89 strains of Escherichia coli, 56 strains of Klebsiella pneumoniae, 14 strains of Enterobacter cloacae, 10 strains of bacteria and 4 strains of Pseudomonas aeruginosa (55.3%, 56.6%, 41.2%, 29.4% and 18.2% respectively). The detection rate of ESBLs-producing bacteria in 3-month-old infants was significantly higher (P <0.01). The ESBLs-producing strains were highly resistant to ampicillin, cefazolin, cefuroxime and cefotaxime (resistance rate was 85.55% -100%), and ceftazidime Pymetrozine and Aztreonam were moderately resistant (resistance rates 43.35% -58.38%), and were sensitive to cefoxitin, cefoperazone / sulbactam, piperacillin / tazobactam and imipenem. The rate of ESBLs-resistant bacteria was significantly higher than non-ESBLs-producing bacteria (P <0.01). Conclusion: The ESBLs producing CAP in infants and young children are mostly Escherichia coli and Klebsiella pneumoniae. The detection rate is closely related to age. The incidence rate of small infants in 3 months is high. The detection rate of commonly used penicillins, cephalosporins Mostly antibiotic antibiotics are mostly resistant to the combination of cephalosporins and enzyme inhibitors, most of which are completely susceptible to carbapenem antibiotics.