【摘要】：目的:分析重慶地區(qū)1-3月齡住院重癥社區(qū)獲得性肺炎(Community-acquired pneumonia,CAP)患兒病原檢出及常見細(xì)菌耐藥情況。方法:回顧性分析2014年1月-2015年12月在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院呼吸病房住院治療的1-3月齡重癥CAP患兒的病原檢出及常見細(xì)菌耐藥情況。結(jié)果:(1)367例患兒鼻咽抽吸物共培養(yǎng)出細(xì)菌268株,其中革蘭氏陰性菌有209株(占檢出細(xì)菌的78.0%),革蘭氏陽性菌有59株(22.0%),優(yōu)勢菌分別為肺炎克雷伯菌肺炎亞種、副流感嗜血桿菌、金黃色葡萄球菌、大腸埃希菌、沙眼衣原體、肺炎鏈球菌;(2)檢出病毒173例,其中呼吸道合胞病毒147例(占檢出病毒例數(shù)的85.0%);(3)混合檢出有118例(32.2%),以細(xì)菌、病毒混合檢出最常見;(4)細(xì)菌藥物敏感試驗(yàn)分析發(fā)現(xiàn):金黃色葡萄球菌除對頭孢西丁耐藥率較前明顯增高外,對其它常用抗生素的耐藥率總體變化不大;肺炎鏈球菌對紅霉素、克林霉素等抗生素仍有極高的耐藥率;革蘭氏陰性菌中肺炎克雷伯菌肺炎亞種、副流感嗜血桿菌、大腸埃希菌對常用抗生素耐藥性總體呈下降趨勢。結(jié)論:重慶地區(qū)1-3月齡住院重癥CAP患兒檢出病原中細(xì)菌占首位,主要為革蘭氏陰性菌,臨床需提高對沙眼衣原體肺炎的認(rèn)識;呼吸道合胞病毒仍是最重要病毒病原;混合檢出以細(xì)菌-病毒混合檢出最常見;分離細(xì)菌對有些抗生素的耐藥整體形勢仍嚴(yán)峻,臨床應(yīng)加強(qiáng)細(xì)菌耐藥情況的監(jiān)測,并根據(jù)本地區(qū)重癥肺炎的病原譜選擇合適的抗生素。
[Abstract]:Aim: to analyze the prevalence of bacterial resistance in hospitalized children with severe community acquired pneumonia (Community-acquired pneumonia,CAP) aged 1-3 months in Chongqing. Methods: from January 2014 to December 2015 in the respiratory ward of Children's Hospital affiliated to Chongqing Medical University, the pathogen detection and common bacterial resistance of children with severe CAP aged 1-3 months were retrospectively analyzed. Results: (1) 268 strains of bacteria were isolated from the nasopharynx aspiration of 367 children. 209 strains (78.0%) of Gram-negative bacteria and 59 strains (22.0%) of Gram-positive bacteria were isolated from children's nasopharynx aspirates, among which 209 strains were Gram-negative bacteria and 59 strains were Gram-positive bacteria (22.0%). The dominant bacteria were Klebsiella pneumoniae, Haemophilus parainfluenza, Staphylococcus aureus, Escherichia coli, Chlamydia trachomatis and Streptococcus pneumoniae. (2) among them, respiratory syncytial virus (RSV) was mixed with respiratory syncytial virus (RSV) (85.0%); (- 3) in 118 cases (32.2%), of which bacteria and viruses were the most common. (4) the analysis of bacterial drug sensitivity test showed that the drug resistance rate of Staphylococcus aureus to cefoxitin was significantly higher than that before, but the resistance rate to other commonly used antibiotics had little change. Among gram-negative bacteria, Klebsiella pneumoniae, Haemophilus parainfluenza and Escherichia coli showed a decreasing trend of resistance to commonly used antibiotics, and the resistance rate of Streptococcus pneumoniae to erythromycin, clindamycin and other antibiotics was still very high. Conclusion: bacteria are the most common pathogens in severe CAP children aged 1-3 months in Chongqing, mainly Gram-negative bacteria, so it is necessary to improve clinical understanding of Chlamydia trachomatis pneumonia, respiratory syncytial virus is still the most important viral pathogen, and respiratory syncytial virus is still the most important pathogen of chlamydia trachomatis pneumonia. The mixed detection of bacteria and viruses was the most common, and the overall situation of drug resistance of isolated bacteria to some antibiotics was still severe, so the surveillance of bacterial drug resistance should be strengthened in clinic, and appropriate antibiotics should be selected according to the pathogen spectrum of severe pneumonia in this area.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.6

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