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目的了解本地区院内获得性肺炎(HAP)的病原学特点及常见细菌的耐药状况。方法将2006年12月~2016年12月期间住院的符合小儿HAP标准的361例患儿作为研究对象,在患儿入院或确诊HAP当天按要求留取痰液标本,按《全国临床检验操作规程》培养分离菌种,采用纸片扩散法进行药物敏感试验。结果 361例共获得阳性标本277例,阳性率为76.73%,共培养出细菌285株,其中G~+球菌75株(26.31%),G~-杆菌210株(73.68%),其中G~-杆菌主要为:肺炎克雷伯菌、大肠埃希菌、铜绿假单孢菌和鲍氏不动菌,共153株(72.85%)(153/210),G~+球菌主要为金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌。G~+球菌对万古霉素尚无耐药菌株,对头孢曲松钠耐药率较低,对其他常用抗生素耐药率较高。肺炎克雷伯菌和大肠杆菌耐药率较低的药物有环丙沙星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦(10.5%~19.5%),鲍氏不动菌对各种抗生素的耐药率较高。结论本地区HAP病原菌以G~-杆菌为主,常见细菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单孢菌和金黄色葡萄球菌,对常用抗生素耐药率高。
Objective To understand the etiological characteristics of nosocomial pneumonia (HAP) and the common bacterial resistance in this area. Methods A total of 361 children admitted to hospital from December 2006 to December 2016 were enrolled in this study, and sputum samples were collected from the patients on admission or confirmed HAP day according to the “National Clinical Laboratory Procedures ”Cultivation of isolated bacteria, using disk diffusion method for drug sensitivity test. Results A total of 277 positive samples were obtained from 361 patients, with a positive rate of 76.73%. A total of 285 bacterial strains were isolated, of which 75 strains (26.31%) were G ~ + cocci and 210 (73.68%) were G ~ The main bacilli were: Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii, a total of 153 strains (72.85%) (153/210), G ~ + cocci mainly Staphylococcus aureus Staphylococcus epidermidis and Streptococcus pneumoniae. There was no drug-resistant strains of vancomycin against G ~ + cocci, the drug resistance rate to ceftriaxone sodium was low, and the drug resistance rate to other commonly used antibiotics was higher. Among the drugs with lower Klebsiella pneumoniae and Escherichia coli resistance, ciprofloxacin, piperacillin / tazobactam and cefoperazone / sulbactam (10.5% -19.5%), Resistance to various antibiotics is high. Conclusions The main pathogen of HAP in this area is G - Bacillus, and the common bacteria are Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, and the rate of resistance to commonly used antibiotics is high.