CAJ | 학술논문

目的：探讨1～6个月龄婴幼儿下呼吸道感染的病原菌分布及对抗生素的耐药情况。方法选择1～6个月龄下呼吸道感染婴幼儿326例，患儿用药前无菌操作取痰标本，标本送细菌培养，并对阳性菌株进行菌株鉴定及药物敏感试验。结果61例患儿痰中检出病原菌，其中检出率为18．71％，5例检出双重细菌，共检出细菌66株。其中，革兰阳性菌33株，占50．00％，革兰阴性菌33株，占50．00％。革兰阳性菌以金黄色葡萄球菌最常见，其次为肺炎链球菌。其中耐甲氧西林金黄色葡萄球菌13株。革兰阴性菌以流感嗜血杆菌最常见，其次为肺炎克雷伯菌肺炎亚种和大肠埃希菌。其中，ESBL 阳性的肺炎克雷伯菌肺炎亚种5株，ESBL 阳性的大肠埃希菌4株。常见的革兰阳性菌对青霉素的耐药率较高，耐甲氧西林金黄色葡萄球菌对青霉素、苯唑西林、红霉素、克林霉素耐药率均较高，尚未发现对万古霉素、利奈唑胺耐药的阳性菌。常见革兰阴性菌对氨苄西林、氨苄西林／舒巴坦、头孢唑啉、头孢曲松耐药率较高，对头孢吡肟、头孢他啶、哌拉西林／他唑巴坦、亚胺培南耐药率低。结论1～6个月龄婴幼儿下呼吸道感染以金黄色葡萄球菌、流感嗜血杆菌、肺炎链球菌、肺炎克雷伯菌、大肠埃希菌为主，对常用抗生素的耐药现象应重视。多重耐药菌以耐甲氧西林金黄色葡萄球菌及 ESBL 阳性细菌最常见，应尽早根据药敏结果合理选用抗生素。
목적：탐토1～6개월령영유인하호흡도감염적병원균분포급대항생소적내약정황。방법선택1～6개월령하호흡도감염영유인326례，환인용약전무균조작취담표본，표본송세균배양，병대양성균주진행균주감정급약물민감시험。결과61례환인담중검출병원균，기중검출솔위18．71％，5례검출쌍중세균，공검출세균66주。기중，혁란양성균33주，점50．00％，혁란음성균33주，점50．00％。혁란양성균이금황색포도구균최상견，기차위폐염련구균。기중내갑양서림금황색포도구균13주。혁란음성균이류감기혈간균최상견，기차위폐염극뢰백균폐염아충화대장애희균。기중，ESBL 양성적폐염극뢰백균폐염아충5주，ESBL 양성적대장애희균4주。상견적혁란양성균대청매소적내약솔교고，내갑양서림금황색포도구균대청매소、분서서림、홍매소、극림매소내약솔균교고，상미발현대만고매소、리내서알내약적양성균。상견혁란음성균대안변서림、안변서림／서파탄、두포서람、두포곡송내약솔교고，대두포필우、두포타정、고랍서림／타서파탄、아알배남내약솔저。결론1～6개월령영유인하호흡도감염이금황색포도구균、류감기혈간균、폐염련구균、폐염극뢰백균、대장애희균위주，대상용항생소적내약현상응중시。다중내약균이내갑양서림금황색포도구균급 ESBL 양성세균최상견，응진조근거약민결과합리선용항생소。
Objective To investigate the distribution and drug resistance of bacteria in 1 -6 months infants with lower respiratory infection(LRI).Methods Induced sputum was extracted from 326 infants with LRI who were 1 -6 months.Antibiotic susceptibility tests were performed after bacteria had been identified.Results 61 cases were detected pathogenic bacteria and the detection rate of bacteria was 18.71%.5 cases were detected two kinds of bacte-ria.66 bacterial strains were isolated among which gram -positive bacteria(33 strains)accounted for 50.00% and gram -negative bacteria(33 strains)accounted for 50.00%.Staphylococcus aureus was the most common gram -pos-itive bacteria and Streptococcus pneumoniae was the second.13 strains were methicillin -resistant Staphylococcus au-reus(MRSA).Hemophilus influenzae was the most common gram -negative bacteria,followed by Klebsiella pneumo-nia and Escherichia coli among which ESBL positive Klebsiella pneumonia were 5 cases and ESBL positive Escherich-ia coli were 4 cases.The common gram -positive bacteria had higher rate of penicillin resistance.MRSA had higher rate of penicillin,oxacillin,erythomycin and clindamycin resistance.Resistant strains to vancomycin and rina thiazole amine were not found.The common gram -negative bacteria had higher rate of ampicillin,ampicillin/shu tan,cefazo-lin and ceftriaxone resistance and had lower rate of cefepime,ceftazidime,piperacillin/he azole temple and imipenem resistance.Conclusion The common pathogenic bacteria in 1 -6 months infants with lower respiratory infection were Staphylococcus aureus,Hemophilus influenzae,Streptococcus pneumoniae,Klebsiella pneumonia and Escherichia coli. We should pay attention to the common antibiotic resistance.MRSA and ESBL positive bacteria were the common mul-tiple drug resistant bacterias.Reasonable selection of antibiotics should be based on susceptibility results earlier.