ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2012, Vol. 4 ›› Issue (5): 407-414.doi: 10.3969/j.issn.16743865.2012.05.011

• 论著 • 上一篇    下一篇

宝鸡市区儿童下呼吸道感染细菌病原和药物敏感性的多中心研究

魏升云，汤淑斌，李文君，高改兰，李虹，李海英，周继来   

  1. 721000 陕西 宝鸡，宝鸡市人民医院儿科（魏升云，李海英，周继来）；宝鸡市妇幼保健院儿童医院儿科（汤淑斌）；721009 陕西 宝鸡，宝鸡市中心医院儿科（李文君）；721001 陕西 宝鸡，宝鸡市第二人民医院儿科（高改兰）；721014 陕西 宝鸡，宝鸡市陈仓医院儿科（李虹）
  • 出版日期:2012-10-25 发布日期:2019-05-24
  • 通讯作者: 汤淑斌，721000 陕西 宝鸡，宝鸡市妇幼保健院儿童医院儿科。
  • 作者简介:魏升云（1963-），男，主任医师。研究方向：小儿呼吸道感染及免疫疾病。

The multicenter study of bacterial pathogens and drug sensitivity in children with respiratory tract infection in Baoji city#br# WEI Shengyun,TANG Shubin,LI Wenjun,et al.Department of Pediatrics，Baoji Peole's Hospital，Baoji 721000,China

  • Online:2012-10-25 Published:2019-05-24

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摘要：
目的总结宝鸡市区小儿急性下呼吸道感染（ALRI）细菌病原谱的构成和细菌药敏情况。
方法收集201008/201107宝鸡市三区五大医院儿科住院的急性下呼吸道感染患儿6 234例的痰细菌培养鉴定和药物敏感试验结果进行汇总分析。
结果（1）6 234例送检标本中，1 827例份结果阳性，阳性率29.31%。共培养出致病菌1 882株23种，检出前5位致病菌分别为大肠埃希菌（20.72%）、肺炎克雷伯菌（17.48%）、肺炎链球菌（16.84%）、铜绿假单胞菌（6.59%）、金黄色葡萄球菌（6.32%）。（2）宝鸡市区ALRI致病菌66.05%是G-菌，其中绝大多数是肠杆菌科细菌占86.56%，且大肠埃希菌、肺炎克雷伯菌高居前2位占57.84%；而G+球菌共占29.05%；真菌位居第7位。（3）大肠埃希菌、肺炎克雷伯菌，对阿莫西林/克拉维酸、替卡西林/棒酸、头孢西丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦均高度敏感，可作为经验治疗首选的抗菌药物。所有G-杆菌对亚胺培南均无耐药。铜绿假单胞菌在本地区对头孢他啶高度敏感。肺炎链球菌对青霉素耐药率为70.57%，对一至四代头孢菌素、阿莫西林/克拉维酸等均高度敏感。本地区儿童下呼吸道痰葡萄球菌检出者，主要是金黄色葡萄球菌和凝固酶阴性葡萄球菌（CNS），对苯唑青霉素耐药率依次为92.69%、82.69%，在本地区链球菌属导致的儿童细菌性ALRI仅占到3.03%，对青霉素类抗生素高度敏感，仍是首选抗生素。（4）作为导致儿童ALRI占主要病原的肠杆菌科细菌耐药情况严重，条件致病菌、机会致病菌感染率有增高趋势。结论宝鸡市区儿童ALRI细菌病原谱复杂，有其明确的地域性和时代性特点。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌这4类细菌是宝鸡市区0~14岁儿童各年龄组ALRI的常见致病菌；致病菌以革兰阴性肠杆菌为主，各年龄组又各有其特点；对抗菌药物敏感性也有明显的特点，耐药问题也很严峻。

关键词: 下呼吸道感染, 细菌, 病原谱, 药物敏感性, 多中心研究, 儿童

Abstract:
ObjectiveTo summarize spectrum of bacterial pathogens and bacteriasensitive drugs of Baoji children with acute lower respiratory infections (ALRI).
MethodsFrom 201008 to 201107 in three domain District of Baoji City,the children from five hospital pediatric inpatient department with acute lower respiratory tract infection made,a retrospective pooled analysis in 6 234 cases about sputum culture identification and drug susceptibility test results.
Results(1)Of 6 234 cases of censorship specimens,1 827 cases were with positive result, the positive rate being 29.31%.The 1 882 coculture pathogens were divided into 23 kinds and the first 5 pathogens were Escherichia coli(20.72%),Klebsiella pneumoniae(17.48%),Streptococcus pneumoniae(16.84%),Pseudomonas aeruginosa(6.59%),Staphylococcus aureus(6.32%).(2)About 66.05% ALRI pathogens were G- bacteria,the vast majority of Enterobacteriaceae accounted for 86.56%,and Escherichia coli,Klebsiella pneumoniae highest in the first two accounted for 57.84%;G+cocci accounted for 29.05%;fungi ranked the seven.(3)Escherichia coli and Klebsiella pneumoniae were highly sensitive to Amoxicillin/Clavulanic acid,Ticarcillin/Clavulanic acid,Cefoxitin,Cefoperazone/Sulbactam,Piperacillin/Cilostazol Tazobactam,and could be used as an empiric antimicrobial treatment.All G- bacteria had no resistance to Imipenem.Pseudomonas aeruginosa in the region was highly sensitive to Ceftazidime.Resistance rate of streptococcus pneumoniae to penicillin was 70.57%,highly sensitive to the one to fourgeneration cephalosporins and amoxicillin/Clavulanic acid.Children in the region with lower respiratory tract sputum staphylococcus mainly had Staphylococcus aureus and coagulasenegative staphylococci(CNS),with oxacillin resistance rate being 92.69% and 82.69%;Streptococcus in the region leading to bacterial ALRI in children accounted for only 3.03% , highly sensitive to the antibiotics, so penicillin was still the preferred antibiotic.(4)Enterobacteriaceae as ALRI predominant pathogen in children had serious resistance,and opportunistic pathogen and opportunistic infection rates were likely to increase.
ConclusionsIn Baoji children ALRI bacterial pathogen spectrum has clear region and time features.Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,Streptococcus pneumoniae are 4 common pathogens in 0~14 yearold children in Baoji;pathogenic bacteria are mainly Gramnegative Enterobacteriaceae,and each age group has its own characteristics;antimicrobial susceptibility is obvious,and drug resistance problem is very grim.

Key words: lower respiratory infections, bacteria, pathogen spectrum, drug sensitivity, multicenter；children