1-3月龄重症社区获得性肺炎病原检出及细菌耐药性分析

发布时间：2019-04-11 16:27

【摘要】：目的:分析重庆地区1-3月龄住院重症社区获得性肺炎(Community-acquired pneumonia,CAP)患儿病原检出及常见细菌耐药情况。方法:回顾性分析2014年1月-2015年12月在重庆医科大学附属儿童医院呼吸病房住院治疗的1-3月龄重症CAP患儿的病原检出及常见细菌耐药情况。结果:(1)367例患儿鼻咽抽吸物共培养出细菌268株,其中革兰氏阴性菌有209株(占检出细菌的78.0%),革兰氏阳性菌有59株(22.0%),优势菌分别为肺炎克雷伯菌肺炎亚种、副流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌、沙眼衣原体、肺炎链球菌;(2)检出病毒173例,其中呼吸道合胞病毒147例(占检出病毒例数的85.0%);(3)混合检出有118例(32.2%),以细菌、病毒混合检出最常见;(4)细菌药物敏感试验分析发现:金黄色葡萄球菌除对头孢西丁耐药率较前明显增高外,对其它常用抗生素的耐药率总体变化不大;肺炎链球菌对红霉素、克林霉素等抗生素仍有极高的耐药率;革兰氏阴性菌中肺炎克雷伯菌肺炎亚种、副流感嗜血杆菌、大肠埃希菌对常用抗生素耐药性总体呈下降趋势。结论:重庆地区1-3月龄住院重症CAP患儿检出病原中细菌占首位,主要为革兰氏阴性菌,临床需提高对沙眼衣原体肺炎的认识;呼吸道合胞病毒仍是最重要病毒病原;混合检出以细菌-病毒混合检出最常见;分离细菌对有些抗生素的耐药整体形势仍严峻,临床应加强细菌耐药情况的监测,并根据本地区重症肺炎的病原谱选择合适的抗生素。
[Abstract]:Aim: to analyze the prevalence of bacterial resistance in hospitalized children with severe community acquired pneumonia (Community-acquired pneumonia,CAP) aged 1-3 months in Chongqing. Methods: from January 2014 to December 2015 in the respiratory ward of Children's Hospital affiliated to Chongqing Medical University, the pathogen detection and common bacterial resistance of children with severe CAP aged 1-3 months were retrospectively analyzed. Results: (1) 268 strains of bacteria were isolated from the nasopharynx aspiration of 367 children. 209 strains (78.0%) of Gram-negative bacteria and 59 strains (22.0%) of Gram-positive bacteria were isolated from children's nasopharynx aspirates, among which 209 strains were Gram-negative bacteria and 59 strains were Gram-positive bacteria (22.0%). The dominant bacteria were Klebsiella pneumoniae, Haemophilus parainfluenza, Staphylococcus aureus, Escherichia coli, Chlamydia trachomatis and Streptococcus pneumoniae. (2) among them, respiratory syncytial virus (RSV) was mixed with respiratory syncytial virus (RSV) (85.0%); (- 3) in 118 cases (32.2%), of which bacteria and viruses were the most common. (4) the analysis of bacterial drug sensitivity test showed that the drug resistance rate of Staphylococcus aureus to cefoxitin was significantly higher than that before, but the resistance rate to other commonly used antibiotics had little change. Among gram-negative bacteria, Klebsiella pneumoniae, Haemophilus parainfluenza and Escherichia coli showed a decreasing trend of resistance to commonly used antibiotics, and the resistance rate of Streptococcus pneumoniae to erythromycin, clindamycin and other antibiotics was still very high. Conclusion: bacteria are the most common pathogens in severe CAP children aged 1-3 months in Chongqing, mainly Gram-negative bacteria, so it is necessary to improve clinical understanding of Chlamydia trachomatis pneumonia, respiratory syncytial virus is still the most important viral pathogen, and respiratory syncytial virus is still the most important pathogen of chlamydia trachomatis pneumonia. The mixed detection of bacteria and viruses was the most common, and the overall situation of drug resistance of isolated bacteria to some antibiotics was still severe, so the surveillance of bacterial drug resistance should be strengthened in clinic, and appropriate antibiotics should be selected according to the pathogen spectrum of severe pneumonia in this area.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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