CAJ | 학술논문

目的了解儿童社区获得性肺炎病原菌分布并分析其耐药变迁情况,以指导儿科临床更合理地使用抗菌药物.方法将7所医院儿科4806例社区获得性肺炎患儿痰标本进行培养,采用API及全自动细菌鉴定系统分离菌株,根据美国临床实验室国家标准化委员会(NCCLS)制定的标准进行药敏试验,并检测超广谱β-内酰胺酶、AmpC酶及耐甲氧西林的葡萄球菌,将试验阳性资料进行统计分析.结果共分离1127株病原菌,革兰阴性(G-)菌628株(55.7％),其中肺炎克雷伯氏菌多见,大肠埃希氏菌次之；革兰阳性(G+)菌466株(41.4％),以肺炎链球菌为主,金黄色葡萄球菌次之；念珠菌33株(2.9％).G-菌对氨苄西林、第]代头孢类药物耐药率最高(91.4％～94.3％),对亚胺培南敏感.肺炎克雷伯菌、大肠埃希菌产超广谱β-内酰胺酶( ESBLs)与头孢菌素酶(AmpC酶)分别为58.8％、55.0％与19.8％、12.3％；G+菌对青霉素、苯唑西林、红霉素耐药率最高(93.3％～100.0％),对万古霉素敏感.结论儿童社区获得性肺炎病原菌以革兰阴性菌、革兰阳性菌为主.因儿科多选用β-内酰胺类、大环内酯类两大类抗生素,致使病原菌产生ESBLs较高,产AmpC酶菌也占一定比例.细菌耐药情况严重,重视痰培养及药敏检测意义重大.
목적 료해인동사구획득성폐염병원균분포병분석기내약변천정황,이지도인과림상경합리지사용항균약물.방법 장7소의원인과4806례사구획득성폐염환인담표본진행배양,채용API급전자동세균감정계통분리균주,근거미국림상실험실국가표준화위원회(NCCLS)제정적표준진행약민시험,병검측초엄보β-내선알매、AmpC매급내갑양서림적포도구균,장시험양성자료진행통계분석.결과 공분리1127주병원균,혁란음성(G-)균628주(55.7％),기중폐염극뢰백씨균다견,대장애희씨균차지；혁란양성(G+)균466주(41.4％),이폐염련구균위주,금황색포도구균차지；념주균33주(2.9％).G-균대안변서림、제]대두포류약물내약솔최고(91.4％～94.3％),대아알배남민감.폐염극뢰백균、대장애희균산초엄보β-내선알매( ESBLs)여두포균소매(AmpC매)분별위58.8％、55.0％여19.8％、12.3％；G+균대청매소、분서서림、홍매소내약솔최고(93.3％～100.0％),대만고매소민감.결론 인동사구획득성폐염병원균이혁란음성균、혁란양성균위주.인인과다선용β-내선알류、대배내지류량대류항생소,치사병원균산생ESBLs교고,산AmpC매균야점일정비례.세균내약정황엄중,중시담배양급약민검측의의중대.
Objective To analyze the changes of pathogens and drug resistance in communityacquired pneumonia ( CAP ) in children to provide guidence for optimal uses of antibiotics.Methods Sputum samples from 4806 children with CAP at seven hospitals were cultured.Bacterial strains were isolated and identified by API or the MicroScan WalkAway 40 SI.Antimicrobial susceptibility was tested;and ESBLs,AmpC,and MRS were examined according to the criteria of NCCLS guidelines.The WHONET 5.0 software was used for analysis of antimicrobial resistance.Results Among 1127 isolated pathogenic strains,628 ( 55.7％ )were gram-negative,mostly Klebsiella pneumoniae,followed by Escherichia coli,466 ( 41.4％ )were gram-positive cocci,mostly Streptococcus penumoniae,followed by Staphylococcus aureus; 33 ( 2.9％ )were Candida.Gram-negative bacilli had the highest resistant rate ( 91.4％ - 94.3％ )to ampicillin and the first generation of cephalosporins,but is susceptible to imipenem.The rates of producing ESBLs and AmpC were 58.8％ and 19.8％ for Klebsiella pneumonia and 55.0％ and 12.3％ for Escherichia coli,respectively.Gram-positive cocci had the highest resistant rate ( 93.3％ - 100.0％ ) to penicillin,oxacillin sodium,and erythromycin.Conclusions The main pathogens for CAP in children were gramnegative strains and gram-positive cocci.Due to the frequent uses of β-lactams and macrolides in the department of pediatrics,pathogens produce ESBLs and AmpC highly.The pathogens have severe drug resistance to antibiotics.It is of importance for sputum cultures and testing antimicrobial resistance.