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目的了解温州地区儿童急性下呼吸道感染(LRTI)的病原学特点及细菌耐药情况。方法454例急性LRTI患儿(年龄1个月~10岁,中位年龄6.0个月)入院24h内抽取下呼吸道分泌物送细菌培养,药敏试验采用K-B法,同时应用直接免疫荧光法检测呼吸道病毒。结果297例(65.4%)病原检测阳性,其中病毒阳性229例(50.4%),以呼吸道合胞病毒(RSV)最多见(39.6%),其次为副流感病毒3型(PIV3)(6.6%)、腺病毒(2.2%)、流感病毒A型(0.9%)及流感病毒B型(0.7%)。共分离出19种135株(29.7%)致病菌,以肺炎克雷伯杆菌(K.pn)最多见(9.9%),其次为大肠杆菌(E.coli)(4.4%),K.pn和E.coli产ESBLs株分别占42.2%和65.0%;肺炎链球菌(SP)占4.2%。混合感染率为14.8%。6个月以下患儿前5位病原为RSV,K.pn,PIV3,E.coli及SA;而RSV,PIV3,SP,K.pn及E.coli则是6个月至3岁患儿常见的病原。K.pn和E.coli对氨苄西林的耐药率分别达97.8%和75.0%,产ESBLs株的K.pn和E.coli对头孢菌素普遍耐药;SP对红霉素的耐药率高达100%,对青霉素的耐药率亦达68.4%,而SA对红霉素和青霉素的耐药率分别为94.7%和89.5%。结论RSV是温州地区儿童急性LRTI最常见的病原,其次为K.pn和PIV3。常见细菌的抗生素耐药性及革兰阴性杆菌产ESBLs的比率均相当高。
Objective To understand the etiological characteristics and bacterial resistance of children with acute lower respiratory tract infection (LRTI) in Wenzhou area. Methods A total of 454 acute LRTI patients aged from 1 months to 10 years with a median age of 6.0 months were selected for bacterial culture in 24h after admission. The susceptibility test was performed by KB method and the direct immunofluorescence method was used to detect the respiratory tract virus. Results A total of 297 (65.4%) were positive for pathogens, of which 229 were positive (50.4%), the most common was respiratory syncytial virus (RSV) (39.6%), followed by PIV3 (6.6%), , Adenovirus (2.2%), influenza A (0.9%) and influenza B (0.7%). A total of 19 strains of 135 (29.7%) pathogenic bacteria were isolated, of which K. pneumoniae was the most common (9.9%), followed by E. coli (4.4%), K. pn And ESBLs-producing strains of E. coli accounted for 42.2% and 65.0%, respectively; while Streptococcus pneumoniae (SP) accounted for 4.2%. The mixed infection rate was 14.8%. The top 5 pathogens in children younger than 6 months were RSV, K.pn, PIV3, E. coli and SA, while RSV, PIV3, SP, K.pn and E.coli were common in children between 6 months and 3 years of age Of the pathogen. The resistance rates of K.pn and E.coli to ampicillin were 97.8% and 75.0%, respectively. K.pn and E. coli producing ESBLs strains were generally resistant to cephalosporins; the drug resistance rate of erythromycin to SP Up to 100%, the resistance rate to penicillin also reached 68.4%, while the resistance rates of SA to erythromycin and penicillin were 94.7% and 89.5% respectively. Conclusion RSV is the most common pathogen of acute LRTI in children in Wenzhou, followed by K. pn and PIV3. The antibiotic resistance of common bacteria and the rate of ESBLs produced by Gram-negative bacilli are quite high.