儿童下呼吸道感染病原菌的分布及耐药特点分析
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i2.18869
Abstract
目的：分析本院儿童下呼吸道感染阳性病原菌的分布特征及耐药特点，为临床合理用药提供依据。方法：收集2021-2024年间10149例下呼吸道感染患儿痰液标本，进行细菌培养、菌种鉴定及药敏试验。结果：痰培养分离出阳性病原菌688株，阳性率为6.60%（688/10419），革兰阳性菌占36.77%（253/688），革兰阴性菌为63.23%（435/688），其中流感嗜血杆菌、金黄色葡萄球菌、肺炎链球菌、大肠埃希菌和肺炎克雷伯菌的检出率较高；0-3岁婴幼儿易感性明显高于其他年龄段的儿童，差异均有统计学意义（P<0.05）；金黄色葡萄球菌和肺炎链球菌对青霉素耐药率较高；流感嗜血杆菌、大肠埃希菌和肺炎克雷伯菌对氨苄西林的耐药率菌较高；大肠埃希菌对酶抑制剂及头孢菌素呈不同程度的耐药；肺炎克雷伯对碳青霉烯类药物耐药率为20.51%。结论：我院儿童下呼吸道感染病原菌以革兰阴性菌为主，感染率存在年龄差异。临床医生应加强细菌耐药监测，促进抗生素的合理利用，减少耐药菌株的传播和流行。
Keywords
下呼吸道感染；痰培养；药敏试验；碳青霉烯类
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[3] Zhou B,Niu W, Liu F, et al. Risk factors for recurrent respiratory tract infection in preschool-aged children[J]. Pediatr Res,2021,90(1):223-231.
[4] 卢婷,张长庚,许沙沙,等. 衡水地区儿童急性下呼吸道感染病原菌构成与耐药性分析及对病情加重的影响[J]. 广西医科大学学报,2022,39(10):1666-1671.
[5] 徐金梅,张德强,王永霞,等.儿童下呼吸道感染病原菌种类调查及并发哮喘的预测模型构建[J].中国病原生物学杂志,2024,19(7):768-772.
[6] Birindwa AM, Kasereka JK,Gonzales-Siles L,et al. Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia[J]. BMC Infect Dis,2021,21(1):837.
[7] Zhang XL,Liu J, Fu P,et al. Epidemiological profile and antimicrobial resistance trends of Staphylococcus aureus in Chinese pediatric intensive care units from 2016 to 2022: a multi-center retrospective study[J]. BMC Infect Dis, 2025,25(1):298.
[8] 郭燕,胡付品,朱德妹,等. 2023年CHINET中国细菌耐药监测[J].中国感染与化疗杂志,2024,24(6):627-637.
[9] Sachdeva S, Kothari S,Gupta SK, et al. Effect of acute lower respiratory tract infection on pulmonary artery pressure in children with post-tricuspid left-to-right shunt[J]. Cardiol Young,2021,31(5):812-816.
[10] 周艳荣,汪万军,向宇培,等. 12岁以下儿童下呼吸道感染细菌分布和耐药性分析[J].检验医学与临床,2021,18(7):972-975.
[11] Wahl B,O'Brien K L, Greenbaum A,et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15[J]. Lancet Glob Health, 2018,6(7):744-757.
[12] 江载芳,申昆玲,沈颖.诸福棠实用儿科学[M]. 8版.北京:人民卫生出版社,2015:1253-1262.
[13] Hu F, Guo Y,Zhu D, et al. CHINET surveillance of bacterial resistance in China: 2021 report[J]. Chin J Infect Chemother,2022,22(5):521-30.
[14] 孟青,周林涛,陈运生,等.2015-2021年CHINET儿童患者临床分离菌的分布特征和耐药性变迁[J].中国感染与化疗杂志,2025,25(1):48-58.
[15] 倪鑫.儿童社区获得性肺炎诊疗规范(2019年版)[J].全科医学临床与教育,2019,17(9):771-777.
[16] 蔡雪莹,曾惠清,张孝斌,等. 2012-2015 年厦门地区下呼吸道标本分离细菌的分布和药物敏感性分析[J].中国感染与化疗杂志,2016,16(16):774-778.
[17] Man W H,van Houten M A,Merelle M E,et al. Bacterial and viral respiratory tract microbiota and host characteristics in children with lower respiratory tract infections: a matched case-control study[J]. Lancet Respir Med, 2019,7(5):417-426.
[18] 邢学伟, 成少华, 葛昌玲, 等. 儿童下呼吸道感染病原菌分布及耐药情况研究[J]. 中华医院感染学杂志, 2018,28(13):2037-2039.
[19] 国家卫生健康委合理用药专家委员会.国家抗微生物治疗指南[M]. 北京:人民卫生出版社,2023,(4):209.
[20] 陈玉芳,严超燕,连双庆,等. 成人金黄色葡萄球菌血流感染233例的临床特征及预后影响因素[J].中国感染与化疗杂志,2025,25(4):364-370.
[21] Wang FD,Chen YY, Chen TL,et al. Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia[J]. Am J Infect Control, 2008,36:118-122.
[22] Holmes NE,Turnidge JD,Munckhof WJ,et al. Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high vancomycin minimum inhibitory concentrations[J]. J Infect Dis, 2011,204:340-347.
[23] Guo Y, Ding L,Yang Y,et al . Multicenter Antimicrobial Resistance Surveillance of Clinical Isolates from Major Hospitals - China, 2022[J]. China CDC Wkly, 2023, 5(52):1155-1160.
[24] van der Vaart TW,Prins JM,Soetekouw R,et al . All-Cause and Infection-Related Mortality in Staphylococcus aureus Bacteremia, a Multicenter Prospective Cohort Study[J]. Open Forum Infect Dis, 2022, 9(12):ofac653.
[25] 王接新,单小鸥,张春霞,等.重症肺炎患儿病原菌分布特点及耐药性分析[J].中华医院感染学杂志,2017,27(24):5677-5679.
[26] 胡莹,陈群英,杨香春. 2017-2021年宁波市某医院儿童肺炎链球菌感染临床特征和耐药趋势分析[J]. 现代实用医学,2023,35(2):201-204.
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