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目的:分析儿童社区获得性肺炎常见致病菌分布及耐药性,为社区获得性肺炎致病菌耐药情况及治疗药物选择提供参考。方法:对绍兴市人民医院2012年1月-2014年12月儿童社区获得性肺炎患者的分离菌株进行鉴定,并采用K-B法进行药敏试验。结果:该院889例诊断为社区获得性肺炎的病例中共分离出病原菌279株,检出率为31.38%(279/853),其中革兰阴性菌、革兰阳性菌分别检出187例和92例,分别占检出细菌总株数的67.03%和32.97%。肺炎克雷伯杆菌、流感嗜血杆菌、大肠埃希菌、铜绿假单胞菌和鲍式不动杆菌对氨苄西林、头孢呋辛、头孢噻肟钠、头孢他啶的耐药率均较高,其次为阿莫西林/克拉维酸钾、哌拉西林/舒巴坦、头孢哌酮/舒巴坦,对亚胺培南和美罗培南的耐药率最低。肺炎链球菌、金黄色葡萄球菌、溶血葡萄球菌对青霉素、克林霉素的耐药率较高,对氨苄西林/舒巴坦、阿莫西林/克拉维酸钾、头孢唑啉及阿奇霉素的耐药率较低,对万古霉素不耐药。结论:该院儿童社区获得性肺炎细菌病原以革兰阴性菌为主,对氨苄西林、头孢呋辛、头孢噻肟钠、头孢他啶等耐药率较高,对加酶抑制剂的抗生素耐药率相对较低,对亚胺培南、美罗培南及万古霉素的耐药率最低,应加强耐药菌检测并根据分布特点合理选用抗生素。
Objective: To analyze the distribution and drug resistance of common pathogenic bacteria in children with community-acquired pneumonia, and to provide reference for the drug-resistant status of community-acquired pneumonia pathogens and the selection of therapeutic drugs. Methods: The isolated strains of children with community-acquired pneumonia in Shaoxing People’s Hospital from January 2012 to December 2014 were identified and K-B method was used for drug susceptibility testing. Results: A total of 279 pathogenic bacteria were isolated from 889 cases diagnosed as community-acquired pneumonia in this hospital, with a detection rate of 31.38% (279/853). Of these, 187 and 92 were Gram-negative and Gram-positive bacteria, respectively Cases, respectively, accounted for 67.03% and 32.97% of the total number of bacteria detected. Klebsiella pneumoniae, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii were more resistant to ampicillin, cefuroxime, cefotaxime sodium and ceftazidime, and secondly Amoxicillin / clavulanate potassium, piperacillin / sulbactam, cefoperazone / sulbactam, and imipenem and meropenem had the lowest rates of resistance. Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus aureus penicillin, clindamycin higher rate of resistance to ampicillin / sulbactam, amoxicillin / clavulanate potassium, cefazolin and azithromycin resistance Low drug rates, no resistance to vancomycin. CONCLUSION: Gram-negative bacteria are the main pathogenic bacteria of community-acquired pneumonia in children of this hospital. The rates of antibiotic resistance to ampicillin, cefuroxime, cefotaxime sodium and ceftazidime are high. The antibiotic resistance rate Relatively low resistance to imipenem, meropenem and vancomycin is the lowest, should be strengthened drug-resistant bacteria detection and rational use of antibiotics based on the distribution characteristics.