新疆医科大学学报

目的:探讨小儿细菌性肺炎的主要致病菌及其耐药性的变化趋势,指导医师合理使用抗生素治疗肺炎。方法:采用临床流行病学方法,对267例肺炎病例的资料进行回顾性分析,将儿科近10年有关小儿社区及院内获得性肺炎的临床和呼吸道分泌物培养以及药物敏感试验资料进行总结;细菌鉴定以法国梅里埃公司提供的API鉴定法为准,试验采用K-B法(纸片法)和浸液巧克力琼脂法。结果:细菌培养总阳性率为19.56%(267/1365),其中大肠埃希氏菌83例(31.09%),葡萄球菌56例(20.97%),以金黄色葡萄球菌和表皮葡萄球菌为主;假单胞菌40例(14.98%),肺炎克雷伯氏菌28例(10.48%),链球菌12例(4.49%),沙雷氏菌属12例(4.49%),流感嗜血杆菌10例(3.75%),肠杆菌属8例(3.0%);变形杆菌6例(2.25%),肠球菌5例(1.87%),不动杆菌5例(1.87%),其他病菌各1例(0.74%)。药敏试验显示:培养病原中的球菌或杆菌几乎对青霉素及其半合成青霉素、β内酰胺酶抑制剂的青霉素类均耐药和部分耐药;G-杆菌对第三代头孢类、喹诺酮类、氨基糖甙类抗生素尚敏感。球菌类中葡萄球菌仅对喹诺酮类及万古霉素敏感,而对红霉素类几乎都耐药。结论:小儿细菌性肺炎病原的耐药性高,应当重视病原学诊断,合理选择敏感抗生素,减少或避免肺炎耐药菌的产生。

Objective:To discuss transition of the major bacteria of pneumonia and the drug resistance to guide pediatricians for the rational usage of antibiotics.Methods:We have used the way of clinical epidemic investigate to analysis the results of sputum culture and drug sensitivity test in the patient with community acquired pneumonia and hospital acquired pneumonia during the past 10 years in our present study respectively.The way of bacterial confirmed was API which was supplied with Biomerieu company in French.Drug sensitivity test used K-B and pancreas peptone agar.Results:The detective rate of bacteria was 19.56%(267/1,365).The percentage of bacteria was shown Escherichia colli(83/267)31.09%;staphylococci(56/267)20.97%,among staphylococcus,aurous and epidermidis were the major,Klebiella pneumonias was 28/267(10.49%);Pseudomonas spp was 22/367(8.24%);Streptococcus was 12/267(4.49%)Hemophilia influenza was 10/267(3.74%);Serratia was 12/267(4.49%);Enterobacter was 8/267(3.0%).The results of drug sensitivity showed that about all bacteria had almost resisted to penicillin and semisynthetic penicillin,and partly resisted to β-lactamose inhibitor penicillin.Gram negative bacteria were sensitive to third-generation cephalosporin and quinolones and aminoglycosides.All kinds of ball bacteria especially staphylococci were only sensitive to quinolones and vancomycini hydrochloridum but highly resist to erythromycin.Conclusion:It was increased that the incidence of the drug resistence to bacteria in children with pneumonia.Pediatrician should pay attention to etiology diagnosis.We suggest that doctor should select rationally the sensitive antibiotics and avoid the drug-resistance.