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目的:分析重庆医科大学附属儿童医院近10年来儿童社区获得性肺炎(CAP)病原学检测结果,了解CAP病原变迁及耐药情况。方法:回顾性分析该院2014年1-12月住院治疗的1 613例CAP患儿鼻咽抽吸物(或痰液标本)细菌培养、呼吸道7种病毒及支原体检查结果等资料。结果:(1)检出前2位细菌为副流感嗜血杆菌、肺炎链球菌;与2003年及2009年比较,副流感嗜血杆菌、肺炎链球菌检出比增加,流感嗜血杆菌检出比显著减少。婴儿组肺炎克雷伯菌肺炎亚种检出比下降。(2)与2003年及2009年相比,各年龄组腺病毒及支原体检出率增加。(3)病原菌对常用抗生素耐药率有一定程度增高,肺炎链球菌对青霉素耐药率显著下降,为肺炎链球菌敏感药物。结论:儿童CAP病原构成和病原菌耐药性随时间发生变迁,所检出病原菌对常用抗生素有不同程度耐药,做好地区病原及药敏监测,有助于合理选用抗菌药物。
Objective: To analyze the etiopathogenisis of CAP in children in Chongqing Children’s Hospital affiliated to Chongqing Medical University during the past 10 years and to understand the pathogenic changes and drug resistance of CAP. Methods: The data of bacterial culture, respiratory viruses and mycoplasma in 1 613 cases of CAP children hospitalized from January to December 2014 in our hospital were retrospectively analyzed. Results: (1) The first two bacteria were identified as Haemophilus parainfluenzae and Streptococcus pneumoniae. Compared with 2003 and 2009, the detection rate of Haemophilus parainfluenzae and Streptococcus pneumoniae increased, and Haemophilus influenzae was detected Than the significant reduction. Infant group Klebsiella pneumoniae pneumonia detected lower than the rate. (2) Compared with 2003 and 2009, the detection rate of adenovirus and mycoplasma increased in all age groups. (3) The rate of resistance of common pathogens to common antibiotics increased to a certain extent, the rate of resistance to streptococcus pneumoniae to penicillin was significantly decreased, which was a sensitive drug for Streptococcus pneumoniae. Conclusion: Children constitute CAP pathogens and pathogen resistance changes occur over time, the detected pathogens have different degrees of resistance to commonly used antibiotics, good areas and pathogen susceptibility monitoring, help in the rational use of antimicrobial drugs.