我院儿科2015-2017年痰培养病原菌分布及耐药性分析
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摘要
目的:了解我院儿科患儿痰培养病原菌分布及耐药情况,为临床合理使用抗菌药物提供参考。方法:筛选我院儿科2015-2017年做痰培养检查的出院病例,对分离的病原菌及其耐药性进行分析与总结。结果:3 900份标本共检出病原菌1 003株(阳性率25.72%),其中革兰阳性菌351株(35.00%),革兰阴性菌617株(61.52%),真菌35株(3.49%);检出菌排名前5位的分别是大肠埃希菌260株(25.92%)、肺炎链球菌239株(23.83%)、肺炎克雷伯菌141株(14.06%)、金黄色葡萄球菌107株(10.67%)和流感嗜血杆菌64株(6.38%)。革兰阳性菌对红霉素、克林霉素和青霉素的耐药率较高,其中肺炎链球菌对红霉素的耐药率为97.91%,金黄色葡萄球菌对青霉素的耐药率为96.33%。革兰阴性菌对第三代、第四代头孢菌素、含酶抑制剂的β-内酰胺类、单环β-内酰胺类、碳青霉烯类药物的耐药率较低,其中大肠埃希菌和肺炎克雷伯菌对头孢他啶的耐药率分别为13.85%和36.62%。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为15.89%,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌检出率分别为48.46%和51.06%。结论:我院儿科住院患者痰培养检出的病原菌以革兰阴性菌为主,不同病原菌对常用抗菌药物的耐药性不同,临床可参考细菌药敏试验结果选用抗菌药物,以提高疗效,减少耐药菌株的产生。
Objective: To investigate the distribution of pathogenic bacteria and drug resistance of pediatric sputum culture in pediatrics of our hospital,so as to provide reference for the rational use of antibiotics in clinic. Methods: Discharged cases of paediatrics in our hospital who underwent sputum culture examination from 2015 to 2017 were screened out,and the isolated pathogens and the drug resistance were analyzed and summarized. Results: A total of 1,003 strains of pathogenic bacteria(positive rate 25.72%) were detected in 3,900 specimens,including 351 strains(35.00%) of gram-positive bacteria,617 strains(61.52%) of gram-negative bacteria,and 35 strains(3.49%) of fungi. The top 5 pathogenic bacteria were Escherichia coli(260 strains,25.92%),Streptococcus pneumoniae(239 strains,23.83%), Klebsiella pneumoniae(141 strains,14.06%), Staphylococcus aureus(107 strains,10.67%) and Haemophilus influenzae(64 strains,6.38%). The resistance rate of gram-positive bacteria to erythromycin,clindamycin and penicillin was relatively high. The resistance rate of S. pneumoniae to erythromycin was 97.91%,and the resistance rate of S. aureus to penicillin was 96.33%. The drug resistance rate of gram-negative bacteria to the third and fourth generation cephalosporins,β-lactamines containing enzyme inhibitors,monocyclic β-lactamines,and carbapenems was relatively low,among which the drug resistance rates of E. coli and K. pneumoniae to cefaladine were 13.85% and 36.62%,respectively. The detection rate of methicillin-resistant S. aureus(MRSA) was 15.89%,and the detection rates of E. coli and K. pneumoniae producing extended-spectrum β-lactamase(ESBLs) were 48.46% and 51.06%,respectively. Conclusion: The pathogens detected in the sputum culture of pediatric inpatients in our hospital are mainly gram-negative bacteria. Different pathogens have different drug resistance to commonly used antibiotics. Antibiotics can be selected according to the bacterial resistance test in clinic so as to improve the curative effect and reduce the resistance of bacteria.
Objective: To investigate the distribution of pathogenic bacteria and drug resistance of pediatric sputum culture in pediatrics of our hospital,so as to provide reference for the rational use of antibiotics in clinic. Methods: Discharged cases of paediatrics in our hospital who underwent sputum culture examination from 2015 to 2017 were screened out,and the isolated pathogens and the drug resistance were analyzed and summarized. Results: A total of 1,003 strains of pathogenic bacteria(positive rate 25.72%) were detected in 3,900 specimens,including 351 strains(35.00%) of gram-positive bacteria,617 strains(61.52%) of gram-negative bacteria,and 35 strains(3.49%) of fungi. The top 5 pathogenic bacteria were Escherichia coli(260 strains,25.92%),Streptococcus pneumoniae(239 strains,23.83%), Klebsiella pneumoniae(141 strains,14.06%), Staphylococcus aureus(107 strains,10.67%) and Haemophilus influenzae(64 strains,6.38%). The resistance rate of gram-positive bacteria to erythromycin,clindamycin and penicillin was relatively high. The resistance rate of S. pneumoniae to erythromycin was 97.91%,and the resistance rate of S. aureus to penicillin was 96.33%. The drug resistance rate of gram-negative bacteria to the third and fourth generation cephalosporins,β-lactamines containing enzyme inhibitors,monocyclic β-lactamines,and carbapenems was relatively low,among which the drug resistance rates of E. coli and K. pneumoniae to cefaladine were 13.85% and 36.62%,respectively. The detection rate of methicillin-resistant S. aureus(MRSA) was 15.89%,and the detection rates of E. coli and K. pneumoniae producing extended-spectrum β-lactamase(ESBLs) were 48.46% and 51.06%,respectively. Conclusion: The pathogens detected in the sputum culture of pediatric inpatients in our hospital are mainly gram-negative bacteria. Different pathogens have different drug resistance to commonly used antibiotics. Antibiotics can be selected according to the bacterial resistance test in clinic so as to improve the curative effect and reduce the resistance of bacteria.
引文
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[2]林素梅,莫海玲,张守印.我院儿科2016年1-6月支气管肺炎病原学及用药合理性分析[J].儿科药学杂志,2017,23(12):46-48.
[3]刘兴颖,刘根贤.儿童社区获得性肺炎病原菌及其耐药性变迁分析[J].中国卫生检验杂志,2017,27(11):1658-1664.
[4]中华医学会儿科学分会呼吸学组.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):856.
[5]汪复,张婴元.实用抗感染治疗学[M].北京:人民卫生出版社,2012:4.
[6]倪莎莎,陈蓓蕾,马依晨,等.儿科住院患儿下呼吸道感染的病原菌分布及耐药性分析[J].现代生物医学进展,2017,17(13):2546-2549.
[7]周华,李光辉,陈佰义,等.中国产超广谱β-内酰胺酶肠杆菌科细菌感染应对策略专家共识[J].中华医学杂志,2014,94(24):1847-1856.
[8]陈晓英,张艳,唐小飞,等.基层医院儿科病区病原菌分布及耐药性分析[J].儿科药学杂志,2016,22(3):42-44.