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目的探讨学龄前儿童急性下呼吸道感染的病原菌及耐药性。方法选取2011年1月~2013年12月间在本院住院治疗的0~6岁急性下呼吸道感染的患儿751例,收集痰标本并分离得到病原菌,进行药敏试验。结果本次研究中共检出病原菌291株,其中革兰阳性菌明显高于革兰阴性菌及真菌,差异均有统计学意义(P<0.05)。革兰阳性菌中肺炎链球菌和金黄色葡萄球菌比例明显高于表皮葡萄球菌,差异均有统计学意义(P<0.05);革兰阴性菌中大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌的比例明显高于其他菌株,差异均有统计学意义(P<0.05)。肺炎链球菌在1~3岁的患儿中感染率偏高,大肠埃希菌在1月龄~1岁的患儿中感染率偏高,金黄色葡萄球菌、肺炎克雷伯菌、阴沟肠杆菌在1~6月龄的患儿中感染率偏高。革兰阳性菌中肺炎链球菌对红霉素、氨苄西林等耐药率较高;金黄色葡萄球菌对氨苄西林和青霉素完全耐药。革兰阴性菌中大肠埃希菌对氨苄西林、哌拉西林、头孢唑林的耐药率较高;肺炎克雷伯菌对氨苄西林、哌拉西林等耐药率较高;阴沟肠杆菌对氨苄西林和头孢唑林完全耐药。结论海南地区学龄前儿童急性下呼吸道感染主要为革兰阳性菌,不同菌种对抗生素的敏感性存在差异,医护人员应根据药敏试验结果合理选用抗生素治疗。
Objective To investigate the pathogens and drug resistance of acute lower respiratory tract infection in preschool children. Methods A total of 751 children aged 0-6 years with acute lower respiratory tract infection hospitalized in our hospital from January 2011 to December 2013 were selected. The sputum samples were collected and the pathogens were isolated for susceptibility testing. Results A total of 291 pathogenic bacteria were detected in this study, of which Gram-positive bacteria were significantly higher than those of Gram-negative bacteria and fungi (P <0.05). Gram-positive bacteria in Streptococcus pneumoniae and Staphylococcus aureus was significantly higher than Staphylococcus epidermidis, the differences were statistically significant (P <0.05); Gram-negative bacteria Escherichia coli, Klebsiella pneumoniae, Enterobacteriaceae ratio was significantly higher than other strains, the differences were statistically significant (P <0.05). The infection rate of Streptococcus pneumoniae was high in children aged 1-3 years. The infection rate of Escherichia coli in children aged 1 month to 1 year was high. Staphylococcus aureus, Klebsiella pneumoniae, Bacilli in children aged 1 to 6 months in the high prevalence. Gram-positive bacteria Streptococcus pneumoniae erythromycin, ampicillin and other resistance rates higher; Staphylococcus aureus ampicillin and penicillin completely resistant. Escherichia coli in Gram-negative bacteria had a higher resistance rate to ampicillin, piperacillin and cefazolin. Klebsiella pneumoniae showed higher resistance to ampicillin and piperacillin, Ampicillin and cefazolin are completely resistant. Conclusion The acute lower respiratory tract infection in preschool children in Hainan is mainly Gram-positive bacteria. The sensitivity of different strains to antibiotics is different. Health care workers should choose antibiotics reasonably according to the results of drug sensitivity test.