CAJ | 학술논문

目的：探讨肺炎患儿痰标本分离的病原菌分布特点及对常用抗菌药物的耐药性，为指导临床合理用药提供实验室参考。方法对2011年8月－2013年8月1832例肺炎患儿送检的痰液标本进行细菌学培养与菌株鉴定，采用K‐B法对病原菌进行药敏试验。结果送检的1832份痰液标本中共分离出病原菌746株，阳性率为40．7％，其中革兰阳性菌413株占55．4％，以金黄色葡萄球菌、A群溶血链球菌、凝固酶阴性葡萄球菌、肺炎链球菌为主，革兰阴性菌333株占44．6％，以肺炎克雷伯菌、大肠埃希菌为主；革兰阳性菌对青霉素、红霉素耐药率高，耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率分别为13．6％和34．1％，未发现对替考拉宁、万古霉素和利奈唑胺的耐药株；革兰阴性菌中肺炎克雷伯菌、大肠埃希菌产 ESBLs率分别为26．7％、37．9％，肠杆菌科未发现亚胺培南、美罗培南耐药株。结论肺炎患儿检出的病原菌主要以革兰阳性菌为主，临床常见菌耐药现象严重，临床医师应加强病原学检测理念，及时送检标本，根据细菌学结果合理选择抗菌药物，减少多药耐药菌的产生。
목적：탐토폐염환인담표본분리적병원균분포특점급대상용항균약물적내약성，위지도림상합리용약제공실험실삼고。방법대2011년8월－2013년8월1832례폐염환인송검적담액표본진행세균학배양여균주감정，채용K‐B법대병원균진행약민시험。결과송검적1832빈담액표본중공분리출병원균746주，양성솔위40．7％，기중혁란양성균413주점55．4％，이금황색포도구균、A군용혈련구균、응고매음성포도구균、폐염련구균위주，혁란음성균333주점44．6％，이폐염극뢰백균、대장애희균위주；혁란양성균대청매소、홍매소내약솔고，내갑양서림금황색포도구균（MRSA）、내갑양서림응고매음성포도구균（MRCNS）검출솔분별위13．6％화34．1％，미발현대체고랍저、만고매소화리내서알적내약주；혁란음성균중폐염극뢰백균、대장애희균산 ESBLs솔분별위26．7％、37．9％，장간균과미발현아알배남、미라배남내약주。결론폐염환인검출적병원균주요이혁란양성균위주，림상상견균내약현상엄중，림상의사응가강병원학검측이념，급시송검표본，근거세균학결과합리선택항균약물，감소다약내약균적산생。
OBJECTIVE To explore the distribution of pathogens isolated from sputum specimens of the children with pneumonia and observe the drug resistance to the commonly used antibiotics so as to provide laboratory basis for reasonable clinical use of antibiotics .METHODS From Aug 2011 to Aug 2013 ,the sputum specimens were col‐lected from 1 832 children with pneumonia ,then the bacteriological culture of the submitted specimens was carried out ,and the strains were identified;the drug susceptibility testing for the pathogens was performed by using K‐B method .RESULTS A total of 746 strains of pathogens have been isolated from the 1 832 submitted sputum speci‐mens ,with the positive rate of 40 .7% ,including 413 (55 .4% ) strains of gram‐positive bacteria and 333 (44 .6% ) strains of gram‐negative bacteria;the Staphylococcus aureus ,group A Streptococcus hemolytic ,coagulase‐nega‐tive Staphylococcus ,and Streptococcus pneumoniae were the predominant species of the gram‐positive bacteria;the K lebsiella pneumoniae and Escherichia coli were dominant among the gram‐negative bacteria .The gram‐posi‐tive bacteria were highly resistant to penicillin and erythromycin .The isolation rates of the methicillin‐resistant Staphylococcus aureus (MRSA) and the methicillin‐resistant coagulase‐negative Staphylococcus (MRCNS) were 13 .6% and 34 .1% ,respectively .No strains were found to be resistant to teicoplanin ,vancomycin ,or linezolid . Among the gram‐negative bacteria ,the isolation rates of the ESBLs‐producing K .pneumoniae and E .coli were 26 .7% and 37 .9% ,respectively .No Enterobacteriaceae strains were found to be resistant to imipenem or mero‐penem .CONCLUSION The gram‐positive bacteria are the predominant pathogens isolated from the children with pneumonia ,and the common clinical isolates are highly drug‐resistant .It is necessary for the clinician to strengthen the idea of etiological test ,submit the specimens in a timely manner ,and reasonably use antibiotics on the basis of bacteriological results so as to reduce the multidrug‐resistant strains .