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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 understand the distribution and drug resistance of respiratory tract isolates from children hospitalized with pneumonia in Shanghai Children’s Hospital, and to provide a scientific basis for rational use of antimicrobial agents and clinical experience treatment. Methods: Respiratory specimens were collected from children with pneumonia hospitalized from January 1, 2014 to December 31, 2014 in the hospital for isolation and culture, strain identification and drug sensitivity test. Results: A total of 2 431 respiratory specimens were collected from 674 hospitalized children with pneumonia, of which 1 082 were positive for culture. The positive rate was 44.51%. 932 non-repetitive pathogens were detected, of which 240 were Gram-positive cocci (25.76% ), Gram-negative bacilli 594 (63.73%), fungi 85 (9.12%) and Gram-negative cocci 13 (1.39%). In the age group, the highest positive rate of respiratory tract specimens was found in children aged 1-3 years (54.47%), and the highest positive rate was found in respiratory department (57.35%). Gram-positive cocci maintained high susceptibility to vancomycin, linezolid and moxifloxacin; whereas, in Gram-negative bacilli, Enterobacteriaceae maintained amikacin, tobramycin, and carbapenems in gram-negative bacilli The higher sensitivity, Acinetobacter baumannii resistance to various antimicrobial agents were higher, Stenotrophomonas maltophilia on minocycline and sulfamethoxazole compound to maintain a high sensitivity. CONCLUSIONS: The respiratory tract isolates from children with pneumonia in this hospital are mainly Gram-negative bacteria, but Staphylococcus aureus is still the single constituent with the highest ratio. The highest positive rate is found in children aged 1-3 years A group. Regular monitoring of the distribution and drug resistance of pathogens isolated from respiratory specimens of children with pneumonia will help to grasp the prevalence and drug resistance of pneumonia pathogens in children in this area in time so as to formulate the best empirical treatment plan.