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目的 了解住院肺炎患儿病原菌分布、药敏情况及临床特点。方法 无菌操作吸取患儿鼻咽深部分泌物或气管插管内合格痰标本 ,接种于 5 %羊血琼脂平皿和巧克力平皿培养 ,用最低抑菌浓度 (MIC)法做药敏试验。结果 院内获得性肺炎 (HAP)组及行气管插管治疗的社区获得性肺炎 (CAP Ⅰ )组病原菌以革兰阴性 (G-)菌为主 ,并以铜绿假单胞菌居首位 (2 5 % ) ;未行气管插管治疗的社区获得性肺炎 (CAP Ⅱ )组革兰阳性 (G+ )球菌相对增多 ,并以肺炎链球菌和表皮葡萄球菌为主 (均占 38 2 % ) ,4 6 2 %的肺炎链球菌分离自 1～ 5岁儿童 ,84 6 %的表皮葡萄球菌分离自 6个月以下婴儿。各种G-菌对环丙沙星较敏感 (总敏感率 77 2 % ) ,而对其他多种抗生素耐药率较高 ;肺炎链球菌对青霉素、氨苄青霉素和万古霉素的敏感率均为 84 6 % ;表皮葡萄球菌对万古霉素 10 0 %敏感 ,对头孢三嗪和阿莫西林 /棒酸的敏感率分别为 76 9%和 6 9 2 % ,对青霉素 10 0 %耐药。HAP组多数预后不佳 ,病死率较高 (8 7% ) ;CAP Ⅰ组 17例重症肺炎中 ,1～ 3个月婴儿 11例 (6 4 7% ) ,其中 2例(18 2 % )死亡。结论 近 5年住院分离的多数病原菌对多种常用抗生素普遍耐药 ;肺炎链球菌感染时仍可考虑首选青霉素治疗 ,但应警惕耐青霉素肺炎链球菌的?
Objective To understand the distribution of pathogenic bacteria in hospitalized children with pneumonia, drug sensitivity and clinical features. Methods The nasopharyngeal secretions or endotracheal intubation of qualified sputum samples from children with aseptic operation were inoculated into 5% sheep blood agar plate and chocolate plate for culture, and drug susceptibility test was performed by the minimum inhibitory concentration (MIC) method. Results The pathogenic bacteria of community acquired pneumonia (CAP Ⅰ) in hospital acquired pneumonia (HAP) group and endotracheal intubation were mainly Gram-negative (G-) and Pseudomonas aeruginosa 5%). The prevalence of Gram-positive cocci in community-acquired pneumonia (CAP Ⅱ) group was significantly higher than that in non-tracheal intubation group (both Pneumococcus and Staphylococcus epidermidis) 6 2% of S. pneumoniae isolated from children 1 to 5 years of age, and 84.6% of Staphylococcus epidermidis isolated from infants under 6 months of age. All kinds of G-bacteria were more sensitive to ciprofloxacin (the total sensitivity was 77.2%), while the resistance to other antibiotics was higher. The sensitivity rates of S. pneumoniae to penicillin, ampicillin and vancomycin were 84 6%; Staphylococcus epidermidis was 100% sensitive to vancomycin, the sensitivity rates to cefotaxime and amoxicillin / clavulanic acid were 76.9% and 69.2% respectively, and resistant to penicillin 10%. Most patients in HAP group had poor prognosis and high mortality rate (8.7%). Among 17 severe pneumonia patients in CAP Ⅰ group, 11 (6.47%) were infants in 1 ~ 3 months and 2 (18.2%) died . Conclusions The majority of pathogenic bacteria isolated from hospital in recent 5 years are generally resistant to various commonly used antibiotics. Preferred penicillin can still be considered in the case of pneumococcal infection, but should be alert to penicillin-resistant Streptococcus pneumoniae?