CAJ | 학술논문

目的探讨苏州地区下呼吸道感染住院患儿细菌病原的构成和耐药性.方法回顾性分析2008年1月至2012年12月于苏州大学附属儿童医院呼吸科住院的8 863例进行痰细菌学培养的下呼吸道感染患儿的资料.采用传统手工方法鉴定、分离细菌,纸片扩散法(K-B法)进行药敏试验.采用x2检验或Fisher确切概率法进行统计学检验.结果 8 863例患儿中2 980例痰培养阳性,阳性率为33.6％.共分离出菌株3 283株,其中肺炎链球菌1 182株(13.3％),其次为流感嗜血杆菌530株(6.0％),金黄色葡萄球菌413株(4.7％)和卡他莫拉菌324株(3.7％)等.6个月及以下患儿细菌检出率最高(37.6％),＞6个月～1岁为32.3％,＞1 ～3岁为32.7％,＞3～7岁为33.7％,7岁以上儿童细菌检出率最低,为20.0％.6月以上患儿中检出的细菌以肺炎链球菌为主,而6个月以内患儿大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌的检出率升高.入院前使用抗菌药物的患儿痰细菌培养检出率明显低于未使用抗菌药物的患儿(29.4％:38.8％,x2=26.335,P＜0.01),且抗菌药物使用的时间对细菌的检出率也存在一定影响.药敏试验结果显示,肺炎链球菌及金黄色葡萄球菌分别对阿莫西林及苯唑西林敏感,而大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素类药物的耐药性有升高趋势,对哌拉西林/他唑巴坦及头孢哌酮/舒巴坦仍较敏感.结论肺炎链球菌是苏州地区儿童下呼吸道感染的首要病原菌,不同年龄组患儿检出细菌的构成不同,且入院前使用抗菌药物会影响细菌的检出率.
목적 탐토소주지구하호흡도감염주원환인세균병원적구성화내약성.방법 회고성분석2008년1월지2012년12월우소주대학부속인동의원호흡과주원적8 863례진행담세균학배양적하호흡도감염환인적자료.채용전통수공방법감정、분리세균,지편확산법(K-B법)진행약민시험.채용x2검험혹Fisher학절개솔법진행통계학검험.결과 8 863례환인중2 980례담배양양성,양성솔위33.6％.공분리출균주3 283주,기중폐염련구균1 182주(13.3％),기차위류감기혈간균530주(6.0％),금황색포도구균413주(4.7％)화잡타막랍균324주(3.7％)등.6개월급이하환인세균검출솔최고(37.6％),＞6개월～1세위32.3％,＞1 ～3세위32.7％,＞3～7세위33.7％,7세이상인동세균검출솔최저,위20.0％.6월이상환인중검출적세균이폐염련구균위주,이6개월이내환인대장애희균、폐염극뢰백균화금황색포도구균적검출솔승고.입원전사용항균약물적환인담세균배양검출솔명현저우미사용항균약물적환인(29.4％:38.8％,x2=26.335,P＜0.01),차항균약물사용적시간대세균적검출솔야존재일정영향.약민시험결과현시,폐염련구균급금황색포도구균분별대아막서림급분서서림민감,이대장애희균화폐염극뢰백균대제삼대두포균소류약물적내약성유승고추세,대고랍서림/타서파탄급두포고동/서파탄잉교민감.결론 폐염련구균시소주지구인동하호흡도감염적수요병원균,불동년령조환인검출세균적구성불동,차입원전사용항균약물회영향세균적검출솔.
Objective To investigate the distribution of bacterial pathogens and drug resistance in hospitalized children with lower respiratory tract infections (LRTIs) in Suzhou.Methods Clinical data of 8 863 hospitalized children with LRTIs from Children's Hospital Affiliated to Soochow University during January 2008 and December 2012 were retrospectively analyzed.Sputum culture were conducted and the bacteria were identified by conventional manual method and antibiotic sensitivity tests were performed by K-B method.The Chi-square or Fisher' s exact test were used for statistical analysis.Results Among 8 863 children,2 980 (33.6％) were positive in sputum culture.A total of 3 283 strains of bacteria were isolated,including 1 182 (13.3％) strains of Streptococcus pneumoniae,530 (6.0％) Haemophilus influenzae,413 (4.7％) Staphyloccocus aureus,324(3.7％) Moraxella catarrhalis,etc.The positive rate in ≤6 months age group ranked the top (37.6％),followed by ＞6-12 months (32.3％),＞ 1-3 years (32.7％) and ＞3-7 years (33.7％) age groups.The lowest positive rate was found in age group ＞7 years (20.0％).Streptococcus pneumoniae was the predominant bacterial pathogen in children ＞ 6 months,while the positive rates of Escherichia coli,Staphyloccocus aureus and Klebsiella pneumoniae increased in children aged ≤6 months.The positive rate of sputum bacterial culture was declined when antibiotics were prescribed before admission (29.4％ vs.38.8％,x2 =26.335,P ＜0.01),and it was also influenced by the duration of antibiotics therapy.The positive rate of Escherichia coli was increased when antibiotics were prescribed for more than 7 days before admission.Streptococcus pneumoniae and Staphyloccocus aureus were sensitive to amoxicillin and oxacillin,respectively.Escherichia coli and Klebsiella pneumoniae were increasingly resistant to the third generation cephalosporins,but were still sensitive to piperacillin/tazobactam and cefoperazone/sulbactam.Conclusions Streptococcus pneumoniae is the most common bacterial pathogen of LRTIs in hospitalized children in Suzhou.The distribution of bacterial etiologies varies in different age groups,and the positive rate may also be influenced by use of antibiotics prior to admission.