医学理论与实践
醫學理論與實踐
의학이론여실천
The Journal of Medical Theory and Practice
2014年
3期
293-295
,共3页
小儿肺炎%致病菌%耐药性%抗生素
小兒肺炎%緻病菌%耐藥性%抗生素
소인폐염%치병균%내약성%항생소
Infant pneumonia%Pathogens%Drug resistance%Antibiotics
目的：了解我院小儿致病菌的现状，并对细菌耐药性及多重耐药菌和院感危险因素进行分析，以指导临床防治。方法：回顾性查阅病历，收集2012年3月-2013年2月间小儿肺炎痰培养阳性的临床及实验室资料，对结果进行统计学分析。结果：小儿肺炎痰培养分离致病菌282株，致病菌以革兰氏阴性杆菌为主220株（78．0％），革兰氏阳性菌61株（21．6％），真菌1株（0．4％），其中肺炎克雷伯菌88株（31．2％）、大肠埃希菌79株（28．0％）为最主要致病菌，两者均有较明显的耐药及多重耐药现象。对亚胺培南敏感率仅为79％、81％，对头孢哌酮/舒巴坦敏感率为69％、74％，主要对氧氟沙星、环丙沙星、阿米卡星敏感率高为85％～96％，而对常用抗菌药物头孢他啶、头孢噻肟钠、头孢曲松敏感率为38％～59％，肺炎克雷伯和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）的比例为（43/88、41/79），ESBLs阳性菌株对三代头孢菌素均有＞80％的耐药率。院感和多重耐药菌的危险因素有：年龄小、存在基础疾病、免疫力低下、反复呼吸道感染、使用3种或3种以上抗生素、使用抗生素≥14d。结论：我院小儿肺炎致病菌主要为条件致病菌，以革兰氏阴性杆菌为主，致病菌对常用青霉素、头孢菌素类耐药率较高，对头孢曲松、β-内酰胺酶抑制、亚胺培南等高级抗生素敏感率不理想，应引起临床医师高度重视，必须严格限制使用具有高潜在耐药性的一类抗菌药物。
目的：瞭解我院小兒緻病菌的現狀，併對細菌耐藥性及多重耐藥菌和院感危險因素進行分析，以指導臨床防治。方法：迴顧性查閱病歷，收集2012年3月-2013年2月間小兒肺炎痰培養暘性的臨床及實驗室資料，對結果進行統計學分析。結果：小兒肺炎痰培養分離緻病菌282株，緻病菌以革蘭氏陰性桿菌為主220株（78．0％），革蘭氏暘性菌61株（21．6％），真菌1株（0．4％），其中肺炎剋雷伯菌88株（31．2％）、大腸埃希菌79株（28．0％）為最主要緻病菌，兩者均有較明顯的耐藥及多重耐藥現象。對亞胺培南敏感率僅為79％、81％，對頭孢哌酮/舒巴坦敏感率為69％、74％，主要對氧氟沙星、環丙沙星、阿米卡星敏感率高為85％～96％，而對常用抗菌藥物頭孢他啶、頭孢噻肟鈉、頭孢麯鬆敏感率為38％～59％，肺炎剋雷伯和大腸埃希菌產超廣譜β-內酰胺酶（ESBLs）的比例為（43/88、41/79），ESBLs暘性菌株對三代頭孢菌素均有＞80％的耐藥率。院感和多重耐藥菌的危險因素有：年齡小、存在基礎疾病、免疫力低下、反複呼吸道感染、使用3種或3種以上抗生素、使用抗生素≥14d。結論：我院小兒肺炎緻病菌主要為條件緻病菌，以革蘭氏陰性桿菌為主，緻病菌對常用青黴素、頭孢菌素類耐藥率較高，對頭孢麯鬆、β-內酰胺酶抑製、亞胺培南等高級抗生素敏感率不理想，應引起臨床醫師高度重視，必鬚嚴格限製使用具有高潛在耐藥性的一類抗菌藥物。
목적：료해아원소인치병균적현상，병대세균내약성급다중내약균화원감위험인소진행분석，이지도림상방치。방법：회고성사열병력，수집2012년3월-2013년2월간소인폐염담배양양성적림상급실험실자료，대결과진행통계학분석。결과：소인폐염담배양분리치병균282주，치병균이혁란씨음성간균위주220주（78．0％），혁란씨양성균61주（21．6％），진균1주（0．4％），기중폐염극뢰백균88주（31．2％）、대장애희균79주（28．0％）위최주요치병균，량자균유교명현적내약급다중내약현상。대아알배남민감솔부위79％、81％，대두포고동/서파탄민감솔위69％、74％，주요대양불사성、배병사성、아미잡성민감솔고위85％～96％，이대상용항균약물두포타정、두포새우납、두포곡송민감솔위38％～59％，폐염극뢰백화대장애희균산초엄보β-내선알매（ESBLs）적비례위（43/88、41/79），ESBLs양성균주대삼대두포균소균유＞80％적내약솔。원감화다중내약균적위험인소유：년령소、존재기출질병、면역력저하、반복호흡도감염、사용3충혹3충이상항생소、사용항생소≥14d。결론：아원소인폐염치병균주요위조건치병균，이혁란씨음성간균위주，치병균대상용청매소、두포균소류내약솔교고，대두포곡송、β-내선알매억제、아알배남등고급항생소민감솔불이상，응인기림상의사고도중시，필수엄격한제사용구유고잠재내약성적일류항균약물。
Objective :This paper is an attempt to understand the current situation in our hospital pediatric pathogen , and analyze the multi-resistant bacterial resistance and hospital infection and risk factors in order to guide prevention and treatment .Methods :A retrospective medical records collected from the pediatric pneumonia sputum culture positive clinical and laboratory data ,dated from March 2012 to February 2013 .The results were statistically analyzed .Results:282 pneumonia sputum pathogen developed from the children ;Gram-negative bacilli pathogenic accounted for 220 (78.0% ) ,Gram-positive bacteria 61 (21 .6% ) ,fungal 1 (0 .4% );among which Klebsiella pneumoniae accounted for 88 (31 .2% ) ,Escherichia coli 79 (28 .0% ) as the most important pathogens ,both of these pathogens present more visible and multidrug resistance .These two was only 79% sensitive to imipenem 81% ,for Toubao Pai copper /sulbactam was 69% ,74% ,and was mainly sensitive to ofloxacin ,ciprofloxacin ,amikacin ,high as 85% ~96% ,while the com-monly used antibiotics such as ceftazidime ,cefotaxime ,ceftriaxone ,the susceptibility rate was only 38% ~59% ,for Klebsiella pneumoniae and Escherichia coli super broad-spectrum β-lactamases (ESBLs) ,the ratio stood at (43/88 ,41/79);for ESBLs positive strains were> 80% resistance to the third generation cephalosporins .Hospital infection and multi-drug resistant risk factors :age ,presence of underlying disease ,low immunity ,recurrent respiratory infections , the use of 3 or more than 3 kinds of antibiotics ,use of antibiotics ≥14 days .Conclusion:The hospital pediatric pneumo-nia pathogens were mainly opportunistic pathogen ,which mainly included Gram-negative bacilli These bacteria present a higher resistance rate to commonly used penicillin ,cephalosporin ,ceftriaxone ,β-inside lactamase inhibitory ,imipenem and other senior antibiotic .Clinicians should pay close attention to the use and strictly limit the use of antibiotics which may cause high potential resistance .
