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目的通过对南阳地区≤5岁儿童社区获得性肺炎(CAP)患儿下呼吸道分泌物病原菌的检测,探讨近年儿童CAP病原菌构成和耐药谱的新特点。方法选择2003-11—2005-12来自南阳地区各不同社区于南阳医专附院儿科就诊,符合肺炎诊断标准的儿童CAP住院患者1276例,用多平板不同条件对未抗菌治疗采得的标本进行接种培养,分离菌株采用Bio Merieux VITEK2型全自动微生物仪进行菌种鉴定和药物敏感试验,结果采用WHONET5软件分析处理,得出儿童CAP病原菌种分布构成比及主要致病菌种对常用抗菌药物的耐药率。结果检出病原菌以革兰阴性菌为主,占68·6%(297/433),其中前3位分别为大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌。6种主要革兰阴性菌对氨苄西林、复方磺胺、头孢唑啉显示高抗药性,而对美洛培南、亚安培南高度敏感,对阿米卡星、头孢吡肟较敏感。4种主要革兰阳性菌对万古霉素高度敏感,对利福平、氨苄西林/舒巴坦及左氧氟沙星较敏感。结论儿童CAP病原菌构成在发生变迁,细菌的耐药性也在发生改变,且各地及不同时期存在差异,故应作好病原及药敏监测并改进检测方法,掌握本地区一定时期内儿童CAP的病原学情况。
Objective To explore the characteristics of CAP pathogen composition and drug resistance spectrum in children with acquired pneumonia (CAP) in Nanyang district in children younger than 5 years. Method Selection 2003-11-2005-12 From different communities in Nanyang in Nanyang Medical Affiliated Hospital pediatric treatment, consistent with pneumonia diagnostic criteria for children with CAP inpatients 1276 cases with multi-plate different conditions were not antibacterial treatment of specimens taken Inoculation and Isolation of Strains BioMerieux VITEK2 automatic microbiology instrument was used for identification of bacteria and drug susceptibility test. The results were analyzed by WHONET5 software to find out the distribution ratio of CAP pathogens in children and the main pathogenic strains of common antibacterials Resistance rate. Results The main pathogens were gram-negative bacteria, accounting for 68.6% (297/433). Among them, the top three were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Six major Gram-negative bacteria showed high resistance to ampicillin, sulfamethoxazole and cefazolin, but were highly sensitive to meropenem and amlodipine and more sensitive to amikacin and cefepime. The four major gram-positive bacteria are highly susceptible to vancomycin and are more sensitive to rifampin, ampicillin / sulbactam and levofloxacin. Conclusion The pathogenesis of CAP in children is changing, and the drug resistance of bacteria is also changing. There are differences between different places and at different periods. Therefore, pathogen and drug sensitivity monitoring should be done and the detection methods should be improved. Etiology.