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目的:分析昆明地区社区获得性肺炎(CAP)患儿呼吸道分泌物分离菌株的构成及其对常用抗生素的耐药状况。方法:对2007年7月1日至2008年6月30日间年龄28天～8岁的1 228名诊断为社区获得性肺炎的住院患儿,用药前采集呼吸道分泌物行细菌培养和肺炎支原体(MP)、肺炎衣原体(CP)、沙眼衣原体(CT)培养法检测,采集静脉血查合胞病毒(RSV)、腺病毒(ADV)血清IgM抗体。结果:在1 228例中,呼吸道分泌物培养出细菌369株,检出率为30.0%(369/1 228)。其中革兰阳性菌226株(61.3%,226/369),肺炎链球菌(SP)数量居首位(108/226,47.8%),其次为麻疹孪生球菌(50/226,22.1%)和金黄色葡萄球菌(SA)(27/226,12.0%);革兰阴性菌143株(143/369,38.8%),大肠埃希菌及大肠埃希菌无活性株数量居首位,两种菌共51株,占35.70%(51/143),其次为克雷伯菌属(37/143,25.9%)和卡他莫拉菌(MC)(18/143,12.6%)等;检出RSV 225例、ADV13例、CP 35例、CT8例,检出率分别为18.3%、1.1%、2.9%和0.7%。结论:昆明地区小儿CAP呼吸道分泌物分离菌株,SP居革兰阳性菌首位;大肠埃希菌及大肠埃希菌无活性株居革兰阴性菌首位,细菌与其它病原体的混合感染率为7.08%(87/1228),SP耐药率均低于33%;麻疹孪生球菌对红霉素和青霉素的耐药率均为74.0%;SA对红霉素和青霉素的耐药率分别为59.3%和88.9%;大肠埃希菌的产酶率为77.8%,对多数头孢菌素类和青霉素类药物的耐药率均高于65%。
Objective: To analyze the composition of respiratory secretions isolated from children with community acquired pneumonia (CAP) in Kunming and its resistance to commonly used antibiotics. Methods: A total of 1 228 hospitalized children with community-acquired pneumonia aged 28 days to 8 years old between July 1, 2007, and June 30, 2008 were enrolled in this study. Bacterial cultures of respiratory secretions and Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP) and Chlamydia trachomatis (CT) culture. Serum IgM antibodies against venous blood cells (RSV) and adenovirus (ADV) were collected. Results: Among 1 228 cases, 369 strains of bacteria were cultured in respiratory secretions with the detection rate of 30.0% (369/1 228). Among them, 226 strains of Gram-positive bacteria (61.3%, 226/369) and S. pneumoniae (108 / 226,47.8%) were the first, followed by measles twin strains (50 / 226,22.1%) and gold Staphylococcus aureus (SA) (27 / 226,12.0%); Gram-negative bacteria 143 (143 / 369,38.8%), Escherichia coli and Escherichia coli in the top of the number of inactive strains, A total of 51 strains accounted for 35.70% (51/143), followed by Klebsiella (37 / 143,25.9%) and Moraxella catarrhalis (MC) (18 / 143,12.6% 225 cases, 13 cases of ADV, 35 cases of CP and 8 cases of CT. The detection rates were 18.3%, 1.1%, 2.9% and 0.7% respectively. CONCLUSIONS: Klebsiella pneumoniae isolates from children with CAP respiratory secretions in Kunming are the most common, Escherichia coli and Escherichia coli inactive strains are the first in gram-negative bacteria, and the mixed infection rates of bacteria and other pathogens are 7.08% (87/1228). The resistance rate of SP to both strains was lower than 33%. The resistant rates of T. measles to erythromycin and penicillin were both 74.0%. The resistance rates of SA to erythromycin and penicillin were 59.3% and 88.9%; Escherichia coli producing enzyme rate was 77.8%, most of the cephalosporins and penicillins resistance rates were higher than 65%.