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目的了解儿童下呼吸道感染革兰阴性菌的流行趋势和药物敏感性,为临床合理用药提供依据。方法分别对2014年南京医科大学附属南京儿童医院收治患儿的痰培养标本和南京医科大学附属鼓楼医院收治的成人患者痰培养标本进行病原菌培养以及药敏试验,并进行对比性分析。结果患儿的下呼吸道痰标本中分离出病原菌6 124株,其中革兰阴性菌3 840株,占62.7%,其分布较多的是流感嗜血杆菌(n=981)、肺炎克雷伯菌(n=729)、大肠埃希菌(n=680)、鲍曼不动杆菌(n=448)、铜绿假单胞菌(n=278)。成人患者的下呼吸道痰标本中分离出病原菌6786株,其中革兰阴性菌4 906株,占72.3%,其分布较多的是肺炎克雷伯菌(n=1 178)、大肠埃希菌(n=1 080)、铜绿假单胞菌(n=981)、鲍曼不动杆菌(n=883)。对革兰阴性菌敏感的药物有哌拉西林/他唑巴坦和亚胺培南。结论儿童下呼吸道感染病原菌以革兰阴性菌为主,且流感嗜血杆菌成为首要病原菌,加强细菌培养和耐药性监测对临床合理使用抗生素十分必要。
Objective To understand the prevalence and drug susceptibility of Gram-negative bacteria in children with lower respiratory tract infection and provide the basis for clinical rational drug use. Methods The sputum culture specimens of sputum from Nanjing Children's Hospital Affiliated to Nanjing Medical University in 2014 and the sputum culture specimens from adult patients admitted to Drum Tower Hospital of Nanjing Medical University were tested for pathogen culture and drug susceptibility respectively. Results A total of 6 124 pathogens were isolated from the sputum samples of lower respiratory tract in children. Among them, 3 840 strains of Gram-negative bacteria accounted for 62.7% of the total, of which Haemophilus influenzae (n = 981), Klebsiella pneumoniae (n = 729), Escherichia coli (n = 680), Acinetobacter baumannii (n = 448) and Pseudomonas aeruginosa (n = 278). 6786 strains of pathogens were isolated from the sputum of lower respiratory tract in adult patients, of which 4 906 strains were Gram-negative bacteria accounting for 72.3%. Klebsiella pneumoniae (n = 1 178), Escherichia coli n = 1080), Pseudomonas aeruginosa (n = 981), Acinetobacter baumannii (n = 883). Drugs that are sensitive to Gram-negative bacteria are piperacillin / tazobactam and imipenem. Conclusions Gram-negative bacteria are the main pathogenic bacteria in children with lower respiratory tract infection, and Haemophilus influenzae is the most important pathogen. To strengthen the culture of bacteria and monitoring of drug resistance is very necessary for rational use of antibiotics in clinical practice.