2015—2018年黄石市中心医院不同年龄段儿童下呼吸道感染病原菌的分布及耐药性分析
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摘要
目的探讨和分析黄石市中心医院不同年龄段儿童下呼吸道感染病原菌的分布及耐药性,指导临床合理选择抗菌药物。方法对2015年1月—2018年5月黄石市中心医院儿科住院患者下呼吸道分泌物标本进行细菌培养、非典病原体和病毒检测,并采用纸片扩散法对细菌进行药敏监测。结果共分离出1298株病原菌,其中革兰阳性菌377株,占29.04%,主要为肺炎链球菌、金黄色葡萄球菌;革兰阴性菌485株,占37.36%,主要为肺炎克雷伯杆菌、流感嗜血杆菌;非典型病原体246株,占18.95%,主要为肺炎支原体;病毒190株,占14.64%。0～3岁组的革兰阳性菌、病毒和非典型病原体分离率显著小于3～7岁组和>7岁组,差异具有统计学意义(P<0.05),而0～3岁组的革兰阴性菌分离率显著大于3～7岁组和>7岁组,差异具有统计学意义(P<0.05)。药敏结果显示肺炎链球菌对氨苄西林舒巴坦、头孢唑林、克林霉素、阿奇霉素的耐药率较高,肺炎克雷伯杆菌对氨苄西林舒巴坦、头孢呋辛、头孢噻肟、氨曲南、妥布霉素等耐药率较高。0～3岁组肺炎链球菌和肺炎克雷伯杆菌等对常见抗菌药物的耐药率大于3～7岁组和>7岁组。结论黄石市中心医院不同年龄的感染率和细菌耐药率存在明显差异,临床应根据不同年龄段患儿病原菌分布特点及耐药趋势,合理选择抗菌药物。
Objective To probe into and analyze the distribution characteristics and drug resistance of pathogens in children of different ages with lower respiratory tract infections in Huangshi Central Hospital, and to provide basis for rational use of antimicrobial agents. Methods Specimens of lower respiratory tract infections from pediatric inpatients in Huangshi Central Hospital from January 2015 to May 2018 were selected, in which bacteria were cultivated, SARS pathogens and virus were detected, and drug sensitivity of bacteria were tested by disk diffusion method. Results A total of 1 298 pathogenic bacteria were isolated, in which Gram-positive bacteria(377 strains) accounted for 29.04%, and main of them were Streptococcus pneumoniae and Staphylococcus aureus. Gram-negative bacteria were 485 strains(37.36%), main of them were Klebsiella pneumoniae and Haemophilus influenzae. Atypical pathogens were 246 strains(18.95%), and main of them were Mycoplasma pneumoniae. Virus were 190 strains, accounting for 14.64%. The isolation rate of Gram-negative bacteria, virus, and atypical pathogens in the 0 — 3 years group was higher than that in the 3 — 7 years group and > 7 years group, with significant difference(P < 0.05). While the isolation rate of Gram-positive bacteria in the 0 — 3 years group was lower than that in the 3 — 7 years group and > 7 years group, with significant difference(P < 0.05). Drug susceptibility results showed that S. pneumoniae had higher resistance rates to ampicillin, sulbacillin, clindamycin, and azithromycin, and K. pneumoniae had higher resistance rates to ampicillin/sulbactam, cefuroxime, cefotaxime, aztreonam, and tobramycin. The drug resistance rate of S. pneumoniae and K. pneumoniae to common antibiotics in the 0 — 3 years group were higher than those in the 3 —7 years group and > 7 years group. Conclusion There are significant differences in infection rates and bacterial resistance rates at different ages in Huangshi Central Hospital. Rational selection of antibacterial drugs should be according to the distribution characteristics of pathogenic bacteria in different age groups and the trend of drug resistance.
Objective To probe into and analyze the distribution characteristics and drug resistance of pathogens in children of different ages with lower respiratory tract infections in Huangshi Central Hospital, and to provide basis for rational use of antimicrobial agents. Methods Specimens of lower respiratory tract infections from pediatric inpatients in Huangshi Central Hospital from January 2015 to May 2018 were selected, in which bacteria were cultivated, SARS pathogens and virus were detected, and drug sensitivity of bacteria were tested by disk diffusion method. Results A total of 1 298 pathogenic bacteria were isolated, in which Gram-positive bacteria(377 strains) accounted for 29.04%, and main of them were Streptococcus pneumoniae and Staphylococcus aureus. Gram-negative bacteria were 485 strains(37.36%), main of them were Klebsiella pneumoniae and Haemophilus influenzae. Atypical pathogens were 246 strains(18.95%), and main of them were Mycoplasma pneumoniae. Virus were 190 strains, accounting for 14.64%. The isolation rate of Gram-negative bacteria, virus, and atypical pathogens in the 0 — 3 years group was higher than that in the 3 — 7 years group and > 7 years group, with significant difference(P < 0.05). While the isolation rate of Gram-positive bacteria in the 0 — 3 years group was lower than that in the 3 — 7 years group and > 7 years group, with significant difference(P < 0.05). Drug susceptibility results showed that S. pneumoniae had higher resistance rates to ampicillin, sulbacillin, clindamycin, and azithromycin, and K. pneumoniae had higher resistance rates to ampicillin/sulbactam, cefuroxime, cefotaxime, aztreonam, and tobramycin. The drug resistance rate of S. pneumoniae and K. pneumoniae to common antibiotics in the 0 — 3 years group were higher than those in the 3 —7 years group and > 7 years group. Conclusion There are significant differences in infection rates and bacterial resistance rates at different ages in Huangshi Central Hospital. Rational selection of antibacterial drugs should be according to the distribution characteristics of pathogenic bacteria in different age groups and the trend of drug resistance.
引文
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[10]倪少娟,陶春凤,周华辉,等.儿科重症监护室和普通病房小儿下呼吸道感染病原学分析[J].中华妇幼临床医学杂志:电子版,2012,8(6):629-633.
[11]李婵,陈楠.某院2012-2016年儿童患者病原菌分布情况与主要病原菌耐药情况分析[J].现代医药卫生,2018,34(7):996-999.
[12]邵肖梅.抗生素治疗新生儿的问题及对策[J].中华儿科杂志,2003,41(12):900-902.
[13]王传清,王爱敏,俞蕙,等.2016年儿童细菌耐药性监测[J].中华儿科杂志,2018,56(1):29-33.
[2]柳鹏程,苏犁云,曹凌峰,等.2011至2014年上海单中心下呼吸道感染住院患儿常见病原体流行病学研究[J].中国循证儿科杂志,2015,10(6):449-453.
[3]颜云盈,邱宝强,李梅.儿童重症肺炎病原菌分布特点及抗菌药物耐药趋势分析[J].临床儿科杂志,2014,32(3):297-298.
[4]崔娟,王佳,姚慧生,等.2006-2010年儿童肺炎支原体感染流行病学分析[J].中国实用儿科杂志,2015,27(6):446-448.
[5]卫计委医政管理局.全国临床检验操作规程[M].第4版.北京:人民卫生出版社,2015:113-127.
[6]Clinical and Laboratory Standards Institute(CLSI).Performance Standards for Antimicrobial Susceptibility Testing[S].2012:M100-S22.
[7]Rudan I,Chan K Y,Zhang J S,et a1.Causes of deaths in children younger than 5 years in China in 2008[J].Lancet,2010,375(9720):1083-1089
[8]张金峰.2005-2010年小儿下呼吸道感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2012,22(8):1745-1747.
[9]华春珍,俞惠民,陈志敏,等.小儿下呼吸道感染的细菌病原学分析[J].中国当代儿科杂志,2006,8(5):365-367.
[10]倪少娟,陶春凤,周华辉,等.儿科重症监护室和普通病房小儿下呼吸道感染病原学分析[J].中华妇幼临床医学杂志:电子版,2012,8(6):629-633.
[11]李婵,陈楠.某院2012-2016年儿童患者病原菌分布情况与主要病原菌耐药情况分析[J].现代医药卫生,2018,34(7):996-999.
[12]邵肖梅.抗生素治疗新生儿的问题及对策[J].中华儿科杂志,2003,41(12):900-902.
[13]王传清,王爱敏,俞蕙,等.2016年儿童细菌耐药性监测[J].中华儿科杂志,2018,56(1):29-33.