住院肺炎患儿呼吸道标本分离菌及其耐药性分析
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摘要
目的 :了解上海某儿童医院住院肺炎患儿呼吸道标本分离菌的分布和耐药情况,为临床合理使用抗菌药物、提高临床经验性治疗水平提供科学依据。方法:对该院2014年1月1日至12月31日住院的肺炎患儿送检呼吸道标本进行分离培养、菌种鉴定和药敏试验。结果:674例住院肺炎患儿共送检2 431份呼吸道标本,其中培养阳性标本共计1 082份,阳性率为44.51%,检出非重复病原菌932株,其中革兰阳性球菌240株(25.76%),革兰阴性杆菌594株(63.73%),真菌85株(9.12%),革兰阴性球菌13株(1.39%)。年龄分组中,1~3岁组患儿呼吸道标本的阳性检出率(54.47%)最高;就诊科室中,呼吸科的阳性检出率最高(57.35%)。革兰阳性球菌对万古霉素、利奈唑胺和莫西沙星保持高敏感率;而革兰阴性杆菌中,肠杆菌科细菌对阿米卡星、妥布霉素、碳青霉烯类药物保持较高的敏感率,鲍曼不动杆菌对各类抗菌药物耐药率均较高,嗜麦芽窄食单胞菌对米诺环素和复方磺胺甲唑保持较高的敏感率。结论:该院肺炎患儿的呼吸道标本分离菌,总体上以革兰阴性菌为主,但金黄色葡萄球菌仍是构成比最高的单种病原菌,1~3岁儿童是阳性检出率最高的一个群体。定期对肺炎患儿呼吸道标本分离病原菌的分布和耐药情况进行监测,有助于及时掌握本地区儿童肺炎病原菌的流行情况及耐药规律,从而制定最佳的经验治疗方案。
Objective: To investigate the species and drug resistance of pathogens isolated from respiratory specimens of hospitalized children with pneumonia in a children hospital in Shanghai, so as to provide evidence for antimicrobial use and improve the empirical treatment. Methods: From January 1 to December 31, 2014, 2 431 respiratory specimens were cultured, and the pathogens isolated were identified for species and antimicrobial susceptibility tests were performed.Results: Of the 2 431 specimens taken from 674 hospitalized children, 1 082(44.51%) were culture-positive, 932 pathogenic isolates were detected, of which gram-positive coccus, gram-negative bacillus, fungi and gram negative coccus accounted for 25.76%(n=240), 63.73%(n=594), 9.12%(n=85%), and 1.39%(n=13), respectively. Positive rate of culture was the highest in 1-3 years of age group(54.47%), and specimens from department of respiratory diseases was the topranked(57.35%). Gram-positive cocci were highly susceptible to vancomycin, linezolid and moxifloxacin. Among gramnegative bacilli, Enterobacteriaceae were highly susceptible to amikacin, tobramycin and carbapenems. Drug resistance rates of Acinetobacter baumannii to all the antimicrobials tested were high, while Stenotrophomonas maltophilia was highly susceptible to minocycline and sulfamethoxazole. Conclusions: Gram-negative bacteria are the major pathogens isolated from respiratory specimens of children with pneumonia, however, Staphylococcus aureus is the highest among the pathogens isolated. The positive rate of culture in 1-3 years of age group is the highest. Regular surveillance on the distri-bution and drug resistance of pathogens isolated from respiratory specimens of pediatric patients with pneumonia would be helpful for establishing the optimal empirical treatment option.
Objective: To investigate the species and drug resistance of pathogens isolated from respiratory specimens of hospitalized children with pneumonia in a children hospital in Shanghai, so as to provide evidence for antimicrobial use and improve the empirical treatment. Methods: From January 1 to December 31, 2014, 2 431 respiratory specimens were cultured, and the pathogens isolated were identified for species and antimicrobial susceptibility tests were performed.Results: Of the 2 431 specimens taken from 674 hospitalized children, 1 082(44.51%) were culture-positive, 932 pathogenic isolates were detected, of which gram-positive coccus, gram-negative bacillus, fungi and gram negative coccus accounted for 25.76%(n=240), 63.73%(n=594), 9.12%(n=85%), and 1.39%(n=13), respectively. Positive rate of culture was the highest in 1-3 years of age group(54.47%), and specimens from department of respiratory diseases was the topranked(57.35%). Gram-positive cocci were highly susceptible to vancomycin, linezolid and moxifloxacin. Among gramnegative bacilli, Enterobacteriaceae were highly susceptible to amikacin, tobramycin and carbapenems. Drug resistance rates of Acinetobacter baumannii to all the antimicrobials tested were high, while Stenotrophomonas maltophilia was highly susceptible to minocycline and sulfamethoxazole. Conclusions: Gram-negative bacteria are the major pathogens isolated from respiratory specimens of children with pneumonia, however, Staphylococcus aureus is the highest among the pathogens isolated. The positive rate of culture in 1-3 years of age group is the highest. Regular surveillance on the distri-bution and drug resistance of pathogens isolated from respiratory specimens of pediatric patients with pneumonia would be helpful for establishing the optimal empirical treatment option.
引文
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[12]汪玲,陆权,王传清,等.2000~2004年京沪穗渝5家儿童医院革兰阳性球菌耐药情况分析[J].中国循证儿科杂志,2006,1(2):113-121.
[13]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[14]Geng W,Yang Y,Wu D,et al.Community-acquired,methicillin-resistant Staphylococcus aureus isolated from children with community-onset pneumonia in China[J].Pediatr Pulmonol,2010,45(4):387-394.
[15]彭凯伟,郑湘榕,何苗.194株儿童感染鲍曼不动杆菌的临床分布和耐药性分析[J].中国现代医学杂志,2015,25(28):57-61.
[2]Adegbola RA.Childhood pneumonia as a global health priority and the strategic interest of the Bill&Melinda Gates Foundation[J].Clin Infect Dis,2012,54(Suppl 2):S89-S92.
[3]张婷.实验室监测指标对评估儿童重症肺炎病情及预后意义的研究进展[J].中国小儿急救医学,2015,22(12):865-868.
[4]伍云霞,汤丽艳,郑玉强,等.儿童血培养病原菌分布及耐药性分析[J].国际检验医学杂志,2015,36(10):1332-1335.
[5]张倩,樊茂,周敬静,等.2008-2012年昆明市儿童医院50199例患儿血培养结果的变迁及耐药状况分析[J].中国微生态学杂志,2015,27(11):1295-1299.
[6]陈新,周林,钟威达.儿童细菌性肺炎的病原菌及其耐药状况分析[J].中华妇幼临床医学杂志(电子版),2012,8(2):176-179.
[7]张侃,刘喜,于红艳.儿童重症监护室中重症细菌性肺炎病原菌耐药性分析[J].沈阳医学院学报,2011,13(3):142-144.
[8]夏燕亮,葛眉,王珍.高原地区儿童重症监护室呼吸机相关肺炎病原学分析[J].中国当代儿科杂志,2014,16(8):787-790.
[9]Shilo N,Quach C.Pulmonary infections and community associated methicillin resistant Staphylococcus aureus:a dangerous mix?[J].Paediatr Respir Rev,2011,12(3):182-189.
[10]Le J,Lieberman JM.Management of community-associated methicillin-resistant Staphylococcus aureus infections in children[J].Pharmacotherapy,2006,26(12):1758-1770.
[11]Tacconelli E,De Angelis G.Pneumonia due to methicillin-resistant Staphylococcus aureus:clinical features,diagnosis and management[J].Curr Opin Pulm Med,2009,15(3):218-222.
[12]汪玲,陆权,王传清,等.2000~2004年京沪穗渝5家儿童医院革兰阳性球菌耐药情况分析[J].中国循证儿科杂志,2006,1(2):113-121.
[13]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[14]Geng W,Yang Y,Wu D,et al.Community-acquired,methicillin-resistant Staphylococcus aureus isolated from children with community-onset pneumonia in China[J].Pediatr Pulmonol,2010,45(4):387-394.
[15]彭凯伟,郑湘榕,何苗.194株儿童感染鲍曼不动杆菌的临床分布和耐药性分析[J].中国现代医学杂志,2015,25(28):57-61.