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目的了解2011-2014年巴州地区住院患儿肺炎病原菌构成、变迁及耐药情况,以指导临床合理应用抗生素。方法对2011年1月-2014年12月入住巴州医院儿科治疗的4 207例小儿肺炎痰培养的阳性菌株进行回顾性分析,对2011-2012年、2013-2014年不同年度小儿肺炎病原菌构成及药敏结果进行比较分析。结果检出病原菌总阳性率为34.4%(1 447/4 207),2年检出菌株中均以革兰阴性菌(G-)为主,分别为82.4%、72.4%。G-前4位为大肠埃希菌、肺炎克雷白杆菌、铜绿假单胞菌、鲍氏不动杆菌;主要革兰氏阳性菌(G+)为肺炎链球菌及金黄色葡萄球菌。鲍氏不动杆菌及金黄色葡萄球菌呈增多趋势。药敏结果显示:近年来,大肠埃希菌及肺炎克雷伯杆菌对除头孢呋辛、哌拉西林外的多数抗生素均较敏感,铜绿假单胞菌对头孢呋辛钠、头孢曲松耐药率较高,鲍氏不动杆菌广泛耐药,仅对头孢哌酮舒巴坦、亚胺培南敏感,肺炎链球菌对红霉素、复方新洛明、克林霉素的耐药率较高,金黄色葡萄球菌对青霉素、红霉素、克林霉素的耐药率较高,对万古霉素、喹诺酮类药物具有较低的耐药率。亚胺培南及万古霉素耐药率较前增加。结论巴州地区住院患儿肺炎的细菌病原菌以G-为主,不同年度病原菌构成及药敏情况不同,多数病原菌耐药情况呈上升趋势,应依据药敏情况指导临床科学合理使用抗菌素。
Objective To understand the composition, changes and drug resistance of pneumonia inpatients with pneumonia in Bavaria during 2011-2014, so as to guide clinical rational use of antibiotics. Methods A retrospective analysis was performed on 4 207 positive sputum cultures of children with pneumonia admitted to Pediatric Hospital of Bazhou Hospital from January 2011 to December 2014. The results showed that the pathogenic bacteria in children with pneumonia in 2011-2012 and 2013-2014 Drug susceptibility results were compared. Results The total positive rate of pathogenic bacteria was 34.4% (1 447/4 207). Gram-negative bacteria (G-) were found in 2 years, accounting for 82.4% and 72.4% respectively. G-top 4 for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii; the main Gram-positive bacteria (G +) for Streptococcus pneumoniae and Staphylococcus aureus. Acinetobacter baumannii and Staphylococcus aureus showed an increasing trend. Susceptibility results showed that Escherichia coli and Klebsiella pneumoniae were sensitive to most antibiotics except cefuroxime and piperacillin in recent years. Pseudomonas aeruginosa was sensitive to cefuroxime sodium and ceftriaxone High drug rates, Acinetobacter baumannii extensive resistance, only to cefoperazone sulbactam, imipenem susceptible to Streptococcus pneumoniae erythromycin, cotrimoxazole, clindamycin resistance rate High, Staphylococcus aureus penicillin, erythromycin, clindamycin higher resistance rate, vancomycin, quinolone drugs have a lower resistance rate. Imipenem and vancomycin resistant rate increased compared with the previous. Conclusions Bacterial pathogens in children with pneumonia in Bazhou district are mainly G-type. The pathogens in different years are different in composition and drug susceptibility. Most of the pathogens are in the upward trend. Antibiotics should be guided in clinical and rational use based on their susceptibility.