316例重症肺炎患儿细菌病原及耐药性分析
|
摘要
目的了解重症肺炎患儿细菌病原学分布及耐药情况。方法以2016年1月-2017年9月诊断为重症肺炎、完成鼻咽抽吸物(NPA)及支气管肺泡灌洗液(BALF)细菌病原学检查的住院患儿为研究对象,回顾分析其临床资料,分析NPA、BALF细菌病原学检出情况及细菌药敏结果。结果共纳入316例患儿,其中婴儿169例(53.5%),204例(64.6%)合并存在基础疾病,304例(96.2%)出现并发症。NPA与BALF检出的首位细菌为肺炎链球菌,其对红霉素耐药率达98%以上,对四环素、复方新诺明、克林霉素耐药率高达70%以上,对美罗培南耐药率达55%,对青霉素耐药率低于20%,对阿莫西林、头孢噻肟耐药率低于30%,对万古霉素、利福平、利奈唑胺均敏感。NPA与BALF检出的第2位细菌为流感嗜血杆菌,对氨苄西林耐药率达85%以上,对复方新诺明、头孢克洛、头孢呋辛、阿莫西林克拉维酸钾耐药率达55%以上,而对头孢噻肟敏感率高达80%以上。BALF、NPA检出产超广谱β内酰胺酶(ESBLs)肺炎克雷伯菌分别为13株、6株,BALF产ESBLs肺炎克雷伯菌检出率高于NPA(76.5%对37.5%),差异有统计学意义(P<0.05)。肺炎克雷伯菌对氨苄西林耐药率达100%,对头孢噻肟、头孢曲松耐药率达55%以上,而对碳青霉烯类抗生素(美罗培南、亚胺培南)敏感率达80%以上。结论重症肺炎患儿最常见细菌病原体为肺炎链球菌,对青霉素、阿莫西林仍保持较高敏感性,广谱抗生素治疗可能是产ESBLs肺炎克雷伯菌检出增多的原因之一,合理经验性用药对预防耐药菌株的产生有重要作用。
Objective To understand the distribution of bacterial etiology and drug resistance in children with severe pneumonia. Methods The hospitalized children who were diagnosed with severe pneumonia in our hospital from January 2016 to September 2017 and completed the bacterial pathogen examination of nasopharyngeal aspirate(NPA) and bronchoalveolar lavage fluid(BALF) were enrolled, and clinical data, NPA, BALF bacterial pathogen detection and bacterial drug susceptibility results were retrospectively analyzed. Results A total of 316 children with severe pneumonia were enrolled,including 169 infants( 53. 5 %), 204 babies( 64. 6 %) who had a combination of underlying disease and 304 babies( 96. 2 %) who had complications. The first bacteria detected from NPA and BALF were Streptococcus pneumoniae. The resistance rate of Streptococcus pneumoniae to erythromycin was over 98 %, and the resistance rate to tetracycline, compound sulfamethoxazole and clindamycin was over 70 %. The resistance rate of meropenem is as high as 55 %, the resistance rate to penicillin is less than20 %, the resistance rate to amoxicillin and cefotaxime is less than 30 %, and in contrast, it is sensitive to vancomycin, rifampicin and linezolid. The second bacteria detected by NPA and BALF is Haemophilus influenzae, and its resistance rate to ampicillin is over 85%. It is resistant to compound sulfamethoxazole, cefaclor, cefuroxime and amoxicillin clavulanate potassium. The drug resistant rate is more than 55 %, but the sensitivity rate to cefotaxime is as high as 80 %. The resistance rate of Klebsiella pneumoniae to ampicillin was 100 %, the resistance rate to cefotaxime and ceftriaxone was over 55 %, but the sensitivity to carbapenem antibiotics(meropenem, imipenem) is up to 80 %. ESBLs-producing Klebsiella pneumoniae in BALF and NPA was 13 and 6 strains, respectively. The detection rate of Klebsiella pneumoniae from BALF was significantly higher than that from NPA( 76. 5 % vs 37. 5 %, P < 0. 05). Conclusions The most common bacterial pathogen detected in children with severe pneumonia is Streptococcus pneumoniae, which still maintains high sensitivity to penicillin and amoxicillin. Broad-spectrum antibiotic treatment may lead to more frequently detected ESBLs-producing Klebsiella pneumoniae. Appropriate antibiotic use has important role in preventing the emergence of resistant strains.
Objective To understand the distribution of bacterial etiology and drug resistance in children with severe pneumonia. Methods The hospitalized children who were diagnosed with severe pneumonia in our hospital from January 2016 to September 2017 and completed the bacterial pathogen examination of nasopharyngeal aspirate(NPA) and bronchoalveolar lavage fluid(BALF) were enrolled, and clinical data, NPA, BALF bacterial pathogen detection and bacterial drug susceptibility results were retrospectively analyzed. Results A total of 316 children with severe pneumonia were enrolled,including 169 infants( 53. 5 %), 204 babies( 64. 6 %) who had a combination of underlying disease and 304 babies( 96. 2 %) who had complications. The first bacteria detected from NPA and BALF were Streptococcus pneumoniae. The resistance rate of Streptococcus pneumoniae to erythromycin was over 98 %, and the resistance rate to tetracycline, compound sulfamethoxazole and clindamycin was over 70 %. The resistance rate of meropenem is as high as 55 %, the resistance rate to penicillin is less than20 %, the resistance rate to amoxicillin and cefotaxime is less than 30 %, and in contrast, it is sensitive to vancomycin, rifampicin and linezolid. The second bacteria detected by NPA and BALF is Haemophilus influenzae, and its resistance rate to ampicillin is over 85%. It is resistant to compound sulfamethoxazole, cefaclor, cefuroxime and amoxicillin clavulanate potassium. The drug resistant rate is more than 55 %, but the sensitivity rate to cefotaxime is as high as 80 %. The resistance rate of Klebsiella pneumoniae to ampicillin was 100 %, the resistance rate to cefotaxime and ceftriaxone was over 55 %, but the sensitivity to carbapenem antibiotics(meropenem, imipenem) is up to 80 %. ESBLs-producing Klebsiella pneumoniae in BALF and NPA was 13 and 6 strains, respectively. The detection rate of Klebsiella pneumoniae from BALF was significantly higher than that from NPA( 76. 5 % vs 37. 5 %, P < 0. 05). Conclusions The most common bacterial pathogen detected in children with severe pneumonia is Streptococcus pneumoniae, which still maintains high sensitivity to penicillin and amoxicillin. Broad-spectrum antibiotic treatment may lead to more frequently detected ESBLs-producing Klebsiella pneumoniae. Appropriate antibiotic use has important role in preventing the emergence of resistant strains.
引文
[1]He C,Liu L,Chu Y,et al.National and subnational all-cause and cause-specific child mortality in China,1996-2015:a systematic analysis with implications for the sustainable development goals.[J].Lancet Glob Health,2017,5(2):e186-e197.
[2]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(上)(2013修订)[J].中华儿科杂志,2013,51(10):745-752.
[3]刘恩梅.支气管肺泡灌洗在小儿呼吸系统疾病中的临床应用[J].临床儿科杂志,2009,27(1):15-17.
[4]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(下)(2013修订)[J].中华儿科杂志,2013,51(11):856-862.
[5]中华医学会儿科学分会呼吸学组儿科支气管镜协作组.儿科支气管镜术指南(2009年版).中华儿科杂志,2009,47(10):740-744.
[6]徐雷,陈蕾,王冲,等.儿童重症肺炎105例临床特征及高危因素分析[J].齐鲁医学杂志,2016,27(3):250-251.
[7]杨明明.重症肺炎患儿临床特征及预后相关因素的回顾性分析[D].重庆医科大学,2009.
[8]Chang AB,Landau LI,Van Asperen PP,et al.Cough in children:definitions and clinical evaluation[J].Med J Aust,2006,184(8):398-403.
[9]Troeger C,Forouzanfar M,Rao PC,et al.Estimates of the global,regional,and national morbidity,mortality,and aetiologies of lower respiratory tract infections in 195countries:a systematic analysis for the Global Burden of Disease Study 2015.[J].Lancet infect Dis.2017,17(11):1133-1161.
[10]董方,王艳,刘锡青,等.2009-2015年北京儿童医院临床分离细菌的分布及耐药性监测[J].中国感染与化疗杂志,2017,17(1):61-70.
[11]王淑会,季伟,张新星,等.苏州地区14994例儿童呼吸道感染细菌病原学特点[J].中国当代儿科杂志,2016,18(1):44-50.
[12]陆芸芸,罗蓉,符州.儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析[J].中国当代儿科杂志,2017,19(9):983-988.
[13]李淑华,何丽雅,邓力,等.抗菌药物管理初期广州地区儿童肺炎链球菌及流感嗜血杆菌耐药性变迁[J].广州药学院学报,2014,30(6):740-743.
[14]刘立涛,万莉红,邵振俊,等.Ⅰ类整合子介导大肠埃希菌与肺炎克雷伯菌耐药机制的初步研究[J].中国抗生素杂志,2012,37(2):132-136.
[2]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(上)(2013修订)[J].中华儿科杂志,2013,51(10):745-752.
[3]刘恩梅.支气管肺泡灌洗在小儿呼吸系统疾病中的临床应用[J].临床儿科杂志,2009,27(1):15-17.
[4]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(下)(2013修订)[J].中华儿科杂志,2013,51(11):856-862.
[5]中华医学会儿科学分会呼吸学组儿科支气管镜协作组.儿科支气管镜术指南(2009年版).中华儿科杂志,2009,47(10):740-744.
[6]徐雷,陈蕾,王冲,等.儿童重症肺炎105例临床特征及高危因素分析[J].齐鲁医学杂志,2016,27(3):250-251.
[7]杨明明.重症肺炎患儿临床特征及预后相关因素的回顾性分析[D].重庆医科大学,2009.
[8]Chang AB,Landau LI,Van Asperen PP,et al.Cough in children:definitions and clinical evaluation[J].Med J Aust,2006,184(8):398-403.
[9]Troeger C,Forouzanfar M,Rao PC,et al.Estimates of the global,regional,and national morbidity,mortality,and aetiologies of lower respiratory tract infections in 195countries:a systematic analysis for the Global Burden of Disease Study 2015.[J].Lancet infect Dis.2017,17(11):1133-1161.
[10]董方,王艳,刘锡青,等.2009-2015年北京儿童医院临床分离细菌的分布及耐药性监测[J].中国感染与化疗杂志,2017,17(1):61-70.
[11]王淑会,季伟,张新星,等.苏州地区14994例儿童呼吸道感染细菌病原学特点[J].中国当代儿科杂志,2016,18(1):44-50.
[12]陆芸芸,罗蓉,符州.儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析[J].中国当代儿科杂志,2017,19(9):983-988.
[13]李淑华,何丽雅,邓力,等.抗菌药物管理初期广州地区儿童肺炎链球菌及流感嗜血杆菌耐药性变迁[J].广州药学院学报,2014,30(6):740-743.
[14]刘立涛,万莉红,邵振俊,等.Ⅰ类整合子介导大肠埃希菌与肺炎克雷伯菌耐药机制的初步研究[J].中国抗生素杂志,2012,37(2):132-136.