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目的了解本地小儿急性下呼吸道感染的细菌病原学流行特点,流感嗜血杆菌疫苗的接种情况,为临床合理使用抗生素治疗及预防下呼吸道感染提供依据。方法收集2010年5月至2012年4月诊断为小儿急性下呼吸道感染的儿科住院患儿鼻咽抽吸物标本203份,做普通细菌、真菌培养及药敏和耐药性检测;同时做流感嗜血杆菌疫苗的接种情况调查。结果 203份标本中检出致病菌171份,总检出率84.24%,其中革兰阴性菌检出率为69.95%(142/203),革兰阳性菌检出率11.82%(24/203)。≤1岁组、～3岁组和﹥3岁组的致病菌检出率分别为94.56%(139/147)、69.23%(18/26)和46.67%(14/30),致病菌的检出率在各年龄组之间差异有统计学意义(χ2=12.52,P=0.028),3岁以内以革兰阴性菌为主。绝大部分的革兰阴性菌只对头孢三代敏感,革兰阳性菌只对万古霉素敏感。同期住院儿童流感嗜血杆菌疫苗的接种率为23.65%。结论小儿急性下呼吸道感染致病菌已由过去的革兰阳性菌为主逐渐转变为革兰阴性菌为主,年龄小的儿童急性下呼吸道感染以革兰阴性菌为主,应该加强对流感嗜血杆菌疫苗接种的宣教,提高流感嗜血杆菌疫苗和肺炎球菌结合疫苗的接种率。
Objective To understand the epidemiological features of bacterial etiology and the vaccination of Haemophilus influenzae in local pediatric acute lower respiratory tract infection and provide the basis for clinical rational use of antibiotics and prevention of lower respiratory tract infection. Methods Totally 203 nasopharyngeal aspirates from pediatric inpatients with acute lower respiratory tract infection diagnosed in children from May 2010 to April 2012 were collected for routine bacterial and fungal culture and drug susceptibility and drug resistance tests. Investigation of vaccination of Haemophilus vaccine. Results 171 pathogens were detected in 203 samples, with a total detection rate of 84.24%. The detection rate of Gram-negative bacteria was 69.95% (142/203) and that of Gram-positive bacteria was 11.82% (24/203 ). The detection rates of pathogens in patients ≤1 years old, ~ 3 years old and> 3 years old were 94.56% (139/147), 69.23% (18/26) and 46.67% (14/30), respectively (Χ2 = 12.52, P = 0.028). Gram-negative bacteria were the most common within 3 years of age. The vast majority of gram-negative bacteria are only sensitive to cephalosporins three generations, Gram-positive bacteria are only susceptible to vancomycin. Inoculation rate of Haemophilus influenzae vaccine in hospitalized children was 23.65%. Conclusions The pathogens of acute lower respiratory tract infection in children have gradually changed from Gram-positive bacteria to Gram-negative bacteria in the past. Gram-negative bacteria are the main cause of acute lower respiratory tract infection in children with younger age. Propagation of Haemophilus vaccination improves the vaccination rates of Haemophilus influenzae and pneumococcal conjugate vaccines.