摘要
目的观察儿童社区获得性肺炎(community-acquired pneumonia,CAP)细菌感染情况并进行耐药分析,为早期的初始病原学治疗提供依据及临床用药提供参考。方法对CAP住院患儿1 328例采用无菌负压吸引新鲜痰液标本进行细菌培养,检出细菌用纸片扩散法(K-B法)和肉汤稀释法分析其对抗生素的耐药性。结果 1 328份痰标本中细菌检测阳性676份,阳性率50.9%,共检出细菌680株,检出率前5位依次是肺炎链球菌(204株/680株)、肺炎克雷伯菌[130株/680株,其中产超广谱β-内酰胺酶(extended spectrum beta-lactamases,ESBLs)菌8株]、大肠埃希菌(104株/680株,其中产ESBLs菌5株)、金黄色葡萄球菌(88株/680株,其中耐甲氧西林金黄色葡萄球菌10株)、流感嗜血杆菌(36株/680株)。药敏结果显示革兰阳性菌中肺炎链球菌对青霉素耐药率19.6%,对阿莫西林/棒酸耐药率12.7%。金黄色葡萄球菌对青霉素、阿莫西林/棒酸耐药率90.0%以上。革兰阴性菌对氨苄西林、头孢唑啉、头孢曲松、头孢噻肟、复方新诺明耐药率高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、环丙沙星、阿米卡星耐药率低,对美罗培南敏感。结论邯郸地区CAP细菌感染以肺炎链球菌、肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌常见;青霉素及阿莫西林克拉维酸钾敏感的肺炎链球菌占多数;虽然痰液标本对肺炎病原学判断价值有限,但仍是基层医院监测细菌、指导合理用药、减少耐药菌株产生的主要手段。
Objective To investigate bacterial infection and drug resistance in children with community-acquired pneumonia（CAP）,and to provide the basis for early clinical drug therapy.Methods The work investigated 1 328 CAP affected infants in our hospital.Their sputum samples were got through aseptic negative pressure attraction and then bacterial cultivation was made with agar dilution.The bacterial drug resistance was measured through both Kirby-Bauer disc diffusion and broth dilution methods.Results The results revealed 676 positive infants and the positive rate 50.9%.The top five bacteria ranged：Streptococcus pneumonia（204/680）,Klebsiella pneumonia（130/680,including 8 ESBLs）,Escherichia coli（104/680,including 5ESBLs）,Staphylococcus aureus（88/680,including 10MRAS）,and Haemophilus influenzae（36/680）.The analysis of antibiotic susceptibility test revealed that Streptococcus pneumonia in gram-positive bacteria showed 19.6% resistance rate to the penicillin;The drug resistance rate were 12.7% to amoxicillin/clavulanaic acid.Meanwhile,Staphylococcus aureus showed more than 90.0% drug resistance rate to penicillin and amoxicillin/clavulanaic acid.On the other hand,gram-negative bacteria showed high drug resistance rate to ampicillin,cephazolin,ceftriaxone,cefotaxime and cotrimoxazole.But,they showed high sensitivity to meropenem.Conclusion The observations revealed that CAP in our hospital was mainly induced by Streptococcus pneumonia,Klebsiella pnueumoniae,Escherichia coli,Staphylococcus aureus.Most streptococcus pneumonia are sensitive to penicillin and amoxicill in clavulanate potassium.The results are important for testing pathogenic and using antibiotic reasonably,although the sputum samples are limited to the judgment of pneumonia etiology.
出处
《河北医科大学学报》
CAS
2016年第1期40-43,共4页
Journal of Hebei Medical University
关键词
肺炎
抗菌药
耐药性
pneumonia
anti-bacterial agents
drug fastness
