小儿急性呼吸道感染病原学分析
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摘要
目的：了解小儿急性呼吸道感染的病原谱,指导临床合理用药,减缓耐药菌产生。方法：分析兰州大学第一医院2008年1月至2010年12月住院患儿急性呼吸道感染病例共997例,无菌留取呼吸道分泌物,进行常规细菌培养及体外药敏试验,同时进行病毒病原监测,分析兰州地区小儿急性呼吸道感染的病原谱,总结致病菌构成及其耐药性。结果：997例急性呼吸道感染患儿的呼吸道分泌物标本中有425份培养出致病菌,共分离到菌株498株,细菌检出率为42.73%,其中革兰阳性球菌151株,占30.32%,革兰阴性杆菌319株,占64.06%。分离率较高的细菌是：肺炎链球菌83株(16.7%),金黄色葡萄球菌59株(11.8%),大肠埃希菌83株(16.7%),肺炎克雷伯杆菌56株(11.2%),流感嗜血杆菌59株(11.8%),副流感嗜血杆菌51株(10.2%),铜绿假单胞菌9株(1.8%)。肺炎链球菌、大肠埃希菌、肺炎克雷伯杆菌、金黄色葡萄球菌、流感嗜血杆菌和副流感嗜血杆菌在不同年龄组及不同临床诊断组检出率比较差异有统计学意义。金黄色葡萄球菌、大肠埃希菌和副流感嗜血杆菌三年间耐药表型检出率比较差异有统计学意义,均在2009年度检出率最高。有717份标本检测出呼吸道相关病毒,检出率70.92%,检出率较高的病毒是呼吸道合胞病毒(RSV)、人鼻病毒(HRV)、副流感病毒3(PIV3),分别占30.7%、15.61%、10.76%。细菌和病毒总检出率在不同年龄组间比较差异有统计学意义,随着年龄增长检出率有下降趋势。在997例呼吸道感染患儿中,6.92%存在细菌混合感染,19.56%存在病毒混合感染,10.73%存在细菌与病毒混合感染。肺炎链球菌和金黄色葡萄球菌对万古霉素及利奈唑胺最敏感,大肠埃希菌和肺炎克雷伯杆菌对碳青霉烯类最敏感,流感嗜血杆菌和副流感嗜血杆菌对常用抗生素均敏感。结论：三年来本地区住院患儿急性呼吸道感染病原以病毒为主,细菌次之,感染高发年龄在3岁以下常见,病毒以呼吸道合胞病毒为主,细菌以肺炎链球菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯杆菌、流感嗜血杆菌及副流感嗜血杆菌为主。细菌在不同年龄组和不同临床诊断组间检出率比较有显著差异。肺炎链球菌和金黄色葡萄球菌对万古霉素及利奈唑胺最敏感,大肠埃希菌和肺炎克雷伯杆菌对碳青霉烯类最敏感,流感嗜血杆菌和副流感嗜血杆菌对常用抗生素均敏感。临床应以微生物培养及药敏试验为依据,合理选用抗生素,减缓耐药菌株的产生。
Objective:To investigate the pathogen spectrum with acute respiratory infection in children, which conduct how to use antibiotics and decrease the progress of drug resistance.Methods:997hospitalized pediatric patients with acute respiartory tract infection were analyzed in the Department of Pediatrics of First Hospital of Lanzhou University from Jan.2008to Dec.2010. Sterile specimens from respiratory secretions, conduct conventional bacterial culture and in vitro susceptibility testing, monitor viral pathogen, analysis of the pathogenic spectrum of acute respiratory infections of children in Lanzhou Region, and summarize the pathogen composition and resistance. Results:Among the997cases,we cultivated498bacteria of425samples,the detection rate is42.73%.There were151Gram Positive Bacteria(30.32%),319Gram Negative Bacteria(64.06%). Shared the majority proportion bacteria were SP83(16.7%), Ecoli83(16.7%), K.pn56(11.2%), HI59(11.8%),SA59(11.8%), HPI51(10.2%) and PA9(1.8%).All these bacteria except PA had statistically significant difference in detection rate between different age groups and clinical diagnostic groups.The resistance phenotype of SA, E.coli and HPI in detection rate had significant difference in each year and the highest detection rate was in2009. The rate of total virus detection was70.92%ranking top three were RSV(30.77%), HRV(15.61%),PIV(10.76%). There were statistically significant in bacteria and virus decetion rate between different age groups.With the increasing of age,the detection rate trended to decline.Among all these997cases,6.92%specimens were bacteria co-infected,19.56%specimens were virus co-infected and10.73%were both bacteria and virus co-infected. SP and SA were most sensitive to linezolid and vancomycin. E.coli and K.pn were most sensitive to carbapenems.HI and HPI were relatively sensitive to common antibiotics. Conclusion:In the past three years, acute respiratory tract infection pathogens mainly to the virus and followed by bacteria in Lanzhou. Under3years age group have the highest morbidity. RSV was the highest dection rate virus.Among the bacteria,SP and E.coli was the most,flowed by SA,HI,K.pn,and HPI.These bacteria had statistically signifeicant difference in dectection rate between different age groups and clinical diagnostic groups. SP and SA were most sensitive to vancomnycin and linezolid. E.coli and K.pn were most sensitive to carbapenems.HI and HPI were relatively sensitive to common antibiotics. So clinical doctors should use antibiotics based on the microorganism cultivation and sensitivity test in order to decrease the emerging of drugresistance strain.
Objective:To investigate the pathogen spectrum with acute respiratory infection in children, which conduct how to use antibiotics and decrease the progress of drug resistance.Methods:997hospitalized pediatric patients with acute respiartory tract infection were analyzed in the Department of Pediatrics of First Hospital of Lanzhou University from Jan.2008to Dec.2010. Sterile specimens from respiratory secretions, conduct conventional bacterial culture and in vitro susceptibility testing, monitor viral pathogen, analysis of the pathogenic spectrum of acute respiratory infections of children in Lanzhou Region, and summarize the pathogen composition and resistance. Results:Among the997cases,we cultivated498bacteria of425samples,the detection rate is42.73%.There were151Gram Positive Bacteria(30.32%),319Gram Negative Bacteria(64.06%). Shared the majority proportion bacteria were SP83(16.7%), Ecoli83(16.7%), K.pn56(11.2%), HI59(11.8%),SA59(11.8%), HPI51(10.2%) and PA9(1.8%).All these bacteria except PA had statistically significant difference in detection rate between different age groups and clinical diagnostic groups.The resistance phenotype of SA, E.coli and HPI in detection rate had significant difference in each year and the highest detection rate was in2009. The rate of total virus detection was70.92%ranking top three were RSV(30.77%), HRV(15.61%),PIV(10.76%). There were statistically significant in bacteria and virus decetion rate between different age groups.With the increasing of age,the detection rate trended to decline.Among all these997cases,6.92%specimens were bacteria co-infected,19.56%specimens were virus co-infected and10.73%were both bacteria and virus co-infected. SP and SA were most sensitive to linezolid and vancomycin. E.coli and K.pn were most sensitive to carbapenems.HI and HPI were relatively sensitive to common antibiotics. Conclusion:In the past three years, acute respiratory tract infection pathogens mainly to the virus and followed by bacteria in Lanzhou. Under3years age group have the highest morbidity. RSV was the highest dection rate virus.Among the bacteria,SP and E.coli was the most,flowed by SA,HI,K.pn,and HPI.These bacteria had statistically signifeicant difference in dectection rate between different age groups and clinical diagnostic groups. SP and SA were most sensitive to vancomnycin and linezolid. E.coli and K.pn were most sensitive to carbapenems.HI and HPI were relatively sensitive to common antibiotics. So clinical doctors should use antibiotics based on the microorganism cultivation and sensitivity test in order to decrease the emerging of drugresistance strain.
引文
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[8]杜娟and黄金莲.193株婴幼儿痰培养分离菌的种类及药敏分析.in第六届江浙沪儿科学术会议暨儿科学基础与临床研究讲展学术班.2009.中国浙江绍兴.
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[1]庄伟,徐婷,单小云,et al.,副流感嗜血杆菌肺炎18例临床分析[J].临床儿科杂志，2004(11)：737-738.
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[13]M.R. Jacobs,D. Felmingham,P.C. Appelbaum, et al., The Alexander Project 1998-2000:susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents[J]. J Antimicrob Chemother,2003.52(2):229-46.
[14]吴健宁,黄革玲,林健,et al.,95株小儿呼吸道感染肺炎链球菌的耐药性研究[J].中国卫生检验杂志,2010(06)：1429-1430.
[15]李斌,肖曙芳,吴茜,et al.,899例小儿革兰阳性细菌感染的细菌学分类及抗生素耐药性分析fJ].儿科药学杂志,2009(06)：37-40.
[16]D. Nicolau, Clinical and economic implications of antimicrobial resistance for the management of community-acquired respiratory tract infections[J]. J Antimicrob Chemother,2002.50 Suppl S1:61-70.
[17]C. Huang,X.L. Wang,L. Zhang, et al., [Distribution and drug resistance of pathogenic bacteria in children with lower respiratory tract infection from Chengdu Children's Hospital between 2001 and 2006] [Jl. Zhongguo Dang Dai Er Ke Za Zhi,2008.10(1):17-20.
[18]C. Reed,A.J. Kallen,M. Patton, et al., Infection with community-onset Staphylococcus aureus and influenza virus in hospitalized children[J]. Pediatr Infect Dis J.2009.28(7):572-6.
[19]赵明波，刘玲媛,黄永坤,et al.，儿童急性下呼吸道感染病原学研究[J].医学综述,’2007(26)：1572-1574.
[20]黄成,王晓蕾,张砺,et al.,2001-2006年成都市儿童医院常见下呼吸道病原菌分布及耐药性检测[J].中国当代儿科杂志,2008(01)：17-20.
[21]A.A. Medeiros, Nosocomial outbreaks of multiresistant bacteria: extended-spectrum beta-lactamases have arrived in North America[J]. Ann Intern Med,1993.119(5):428-30.
[22]J.P. Quinn, Clinical significance of extended-spectrum beta-lactamases [J]. Eur J Clin Microbiol Infect Dis,1994.13 Suppl 1:S39-42.
[23]D. Hoban and D. Felmingham, The PROTEKT surveillance study: antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections[J]. J Antimicrob Chemother,2002.50 Suppl S1:49-59.
[24]S. Tristram,M.R. JacobsandP.C. Appelbaum, Antimicrobial resistance in Haemophilus influenzae [J]. Clin Microbiol Rev,2007.20(2): 368-89.
[25]K. Gotoh,L. Qin,K. Watanabe, et al., Prevalence of Haemophilus influenzae with resistant genes isolated from young children with acute lower respiratory tract infections in Nha Trang, Vietnam[J]. J Infect Chemother, 2008.14(5):349-53.
[26]S. Garcia-Cobos,J. Campos,E. Lazaro, et al., Ampicillin-resistant non-beta-lactamase-producing Haemophilus influenzae in Spain:recent emergence of clonal isolates with increased resistance to cefotaxime and cefixime[J]. Antimicrob Agents Chemother,2007.51(7):2564-73.
[27]A. Franz,O. Adams,R. Willems, et al., Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection[J]. J Clin Virol,2010.48(4): 239-45.
[28]J.K. Chun,J.H. Lee,H.S. Kim, et al., Establishing a surveillance network for severe lower respiratory tract infections in Korean infants and young children[J]. Eur J Clin Microbiol Infect Dis,2009.28(7):841-4.
[29]N. Farshad,M.J. Saffar,A.R. Khalilian, et al., Respiratory viruses in hospitalized children with acute lower respiratory tract infections, Mazandaran Province, Iran[J]. Indian Pediatr,2008.45(7):590-2.
[30]Z.D. Xie,Y. Xiao,C.Y. Liu, et al., [Three years surveillance of viral etiology of acute lower respiratory tract infection in children from 2007 to 2010][J]. Zhonghua Er Ke Za Zhi,2011.49(10):745-9.
[31]龚向英and杨莲芳,1458例小儿急性下呼吸道感染病原学分析[J].中国现代医生,2010(36)：119-121.
[32]H.Y. Zhang,Z.M. Li,G.L. Zhang, et al., Respiratory viruses in hospitalized children with acute lower respiratory tract infections in harbin, China[J]. Jpn J Infect Dis,2009.62(6):458-60.
[33]H. Nair,V.R. Verma,E. Theodoratou, et al., An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections in children[J]. BMC Public Health,2011.11 Supp13:S30.
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[2]梁友,袁新华and文革生,306例婴儿肺炎痰培养及药敏分析[J].现代中西医结合杂志,2008(07)：993-994.
[3]叶满and文晓君,小儿下呼吸道感染常见病原菌分布及耐药分析[J]验医学与临床,2010(01)：23-24.
[4]严清华，黄友旗,蔡於才,et al.,儿童社区获得性下呼吸道感染病原菌及其耐药现状分析[J].中华医院感染学杂志,2009(24)：3424-3426.
[5]李方去,李向阳,杨锦红,et al.,儿童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,2009(03)：344-346.
[6]李树青,延勇and王清图,小儿急性下呼吸道感染1016例细菌学监测及分析[J]国实用儿科杂志，2005(12)：743-745.
[7]孙亮and邵红,儿童急性下呼吸道革兰氏阴性杆菌感染的耐药性分析[J].安徽医药,2010(01)：77-78.
[8]杜娟and黄金莲.193株婴幼儿痰培养分离菌的种类及药敏分析.in第六届江浙沪儿科学术会议暨儿科学基础与临床研究讲展学术班.2009.中国浙江绍兴.
[9]J. Taneja,A. Malik,M. Rizvi, et al., Acute lower respiratory tract infections in children[J]. Indian Pediatr,2009.46(6):509-11.
[10]李昌崇ana林立,儿童下呼吸道感染常见细菌病原分布及耐药现状[J].临床儿科杂志,2010(02)：106-111.
[1]庄伟,徐婷,单小云,et al.,副流感嗜血杆菌肺炎18例临床分析[J].临床儿科杂志，2004(11)：737-738.
[12]J.H. Song,S.I. Jung,K.S. Ko, et al., High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study)[J]. Antimicrob Agents Chemother,2004.48(6):2101-7.
[13]M.R. Jacobs,D. Felmingham,P.C. Appelbaum, et al., The Alexander Project 1998-2000:susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents[J]. J Antimicrob Chemother,2003.52(2):229-46.
[14]吴健宁,黄革玲,林健,et al.,95株小儿呼吸道感染肺炎链球菌的耐药性研究[J].中国卫生检验杂志,2010(06)：1429-1430.
[15]李斌,肖曙芳,吴茜,et al.,899例小儿革兰阳性细菌感染的细菌学分类及抗生素耐药性分析fJ].儿科药学杂志,2009(06)：37-40.
[16]D. Nicolau, Clinical and economic implications of antimicrobial resistance for the management of community-acquired respiratory tract infections[J]. J Antimicrob Chemother,2002.50 Suppl S1:61-70.
[17]C. Huang,X.L. Wang,L. Zhang, et al., [Distribution and drug resistance of pathogenic bacteria in children with lower respiratory tract infection from Chengdu Children's Hospital between 2001 and 2006] [Jl. Zhongguo Dang Dai Er Ke Za Zhi,2008.10(1):17-20.
[18]C. Reed,A.J. Kallen,M. Patton, et al., Infection with community-onset Staphylococcus aureus and influenza virus in hospitalized children[J]. Pediatr Infect Dis J.2009.28(7):572-6.
[19]赵明波，刘玲媛,黄永坤,et al.，儿童急性下呼吸道感染病原学研究[J].医学综述,’2007(26)：1572-1574.
[20]黄成,王晓蕾,张砺,et al.,2001-2006年成都市儿童医院常见下呼吸道病原菌分布及耐药性检测[J].中国当代儿科杂志,2008(01)：17-20.
[21]A.A. Medeiros, Nosocomial outbreaks of multiresistant bacteria: extended-spectrum beta-lactamases have arrived in North America[J]. Ann Intern Med,1993.119(5):428-30.
[22]J.P. Quinn, Clinical significance of extended-spectrum beta-lactamases [J]. Eur J Clin Microbiol Infect Dis,1994.13 Suppl 1:S39-42.
[23]D. Hoban and D. Felmingham, The PROTEKT surveillance study: antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections[J]. J Antimicrob Chemother,2002.50 Suppl S1:49-59.
[24]S. Tristram,M.R. JacobsandP.C. Appelbaum, Antimicrobial resistance in Haemophilus influenzae [J]. Clin Microbiol Rev,2007.20(2): 368-89.
[25]K. Gotoh,L. Qin,K. Watanabe, et al., Prevalence of Haemophilus influenzae with resistant genes isolated from young children with acute lower respiratory tract infections in Nha Trang, Vietnam[J]. J Infect Chemother, 2008.14(5):349-53.
[26]S. Garcia-Cobos,J. Campos,E. Lazaro, et al., Ampicillin-resistant non-beta-lactamase-producing Haemophilus influenzae in Spain:recent emergence of clonal isolates with increased resistance to cefotaxime and cefixime[J]. Antimicrob Agents Chemother,2007.51(7):2564-73.
[27]A. Franz,O. Adams,R. Willems, et al., Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection[J]. J Clin Virol,2010.48(4): 239-45.
[28]J.K. Chun,J.H. Lee,H.S. Kim, et al., Establishing a surveillance network for severe lower respiratory tract infections in Korean infants and young children[J]. Eur J Clin Microbiol Infect Dis,2009.28(7):841-4.
[29]N. Farshad,M.J. Saffar,A.R. Khalilian, et al., Respiratory viruses in hospitalized children with acute lower respiratory tract infections, Mazandaran Province, Iran[J]. Indian Pediatr,2008.45(7):590-2.
[30]Z.D. Xie,Y. Xiao,C.Y. Liu, et al., [Three years surveillance of viral etiology of acute lower respiratory tract infection in children from 2007 to 2010][J]. Zhonghua Er Ke Za Zhi,2011.49(10):745-9.
[31]龚向英and杨莲芳,1458例小儿急性下呼吸道感染病原学分析[J].中国现代医生,2010(36)：119-121.
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