Pathogens of Bacterial Pneumonia in Children and Its Drug Resistance

doi:10.3877/cma.j.issn.1673-5250.2012.02.023

Objective

To explore pathogens causing bacterial pneumonia in children and drug resistance in hospital, and supply evidence on diagnosis and therapy of a clinical basis.

Methods

From January 2009 to December 2010, a total of 892 children with bacterial pneumonia were involved in this study. All subjects were investigation by Questionnaire of Bacterial Pneumonia in Children and sample were collected. Antimicrobial susceptibility of antibiotics was detected by Kirby-Bauer method. Producing extended spectrum β-lactamases (ESBLs) bacteria were identified by double-disk synergy test. The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of Obstetrics and Gynecology Hospital of Hainan Province. And it was approved by this committee. Guardians or patients were informed of grouping and their written informed consent was obtained before clinical studies.

Results

A total of 155 pathogenic bacteria strains were isolated from 135 children, and isolation rate was 15.13%. The top five bacterial strains were Klebsiella pneumoniae, Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa, which accounted for 22.58%, 17.42%, 14.84%, 13.00% and 10.97% of the total bacteria strains, respectively. Drug resistance rates of Klebsiella pneumoniae, Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa were much more than 80% to penicillin, while much more than 77.0% to Ampicillin and amoxicillin. Drug resistance rate in 2010 was much more than that in 2009. A total of 40 producing ESBLs bacteria strains were identified by double-disk synergy test among tep five bacterial with the detection rate of 32.79%.

Conclusions

All of the bacterial pneumonia in children have the drug resistant feature, and producing ESBLs bacteria are at prevalence to a certain extent.

Key words: bacterial pneumonia, pathogen, drug resistance, child

表1 2009与2010年自本院细菌性肺炎患儿中检出细菌菌株的构成比比较[n(%)]

Table 1 Comparison of constituent ratios of the bacteria strains in bacterial pneumonia in 2009 and 2010 [n(%)]

?	细菌类别	2009年	2010年	总构成比
G^－		?	?	?
?	肺炎克雷伯菌	17 (22.97)	18 (22.22)	35 (22.58)
?	大肠埃希菌	14 (18.92)	13 (16.05)	27 (17.42)
?	铜绿假单胞菌	7 (9.46)	10 (12.35)	17 (10.97)
?	流感嗜血杆菌	3 (4.05)	4 (4.94)	7 (4.52)
?	不动杆菌	2 (2.70)	4 (4.94)	6 (3.87)
?	阴沟肠杆菌	3 (4.05)	2 (2.04)	5 (3.00)
?	溶血性链球菌	2 (2.70)	1 (1.36)	3 (2.00)
G^＋		?	?	?
?	肺炎链球菌	12 (16.22)	11 (13.58)	23 (14.84)
?	金黄色葡萄球菌	8 (10.81)	12 (15.00)	20 (13.00)
?	溶血性葡萄球菌	6 (8.11 )	6 (7.90)	12 (8.00)
?	合计	74(100.00)	81(100.00)	155(100.00)

表1 2009与2010年自本院细菌性肺炎患儿中检出细菌菌株的构成比比较[n(%)]

Table 1 Comparison of constituent ratios of the bacteria strains in bacterial pneumonia in 2009 and 2010 [n(%)]

?	细菌类别	2009年	2010年	总构成比
G^－		?	?	?
?	肺炎克雷伯菌	17 (22.97)	18 (22.22)	35 (22.58)
?	大肠埃希菌	14 (18.92)	13 (16.05)	27 (17.42)
?	铜绿假单胞菌	7 (9.46)	10 (12.35)	17 (10.97)
?	流感嗜血杆菌	3 (4.05)	4 (4.94)	7 (4.52)
?	不动杆菌	2 (2.70)	4 (4.94)	6 (3.87)
?	阴沟肠杆菌	3 (4.05)	2 (2.04)	5 (3.00)
?	溶血性链球菌	2 (2.70)	1 (1.36)	3 (2.00)
G^＋		?	?	?
?	肺炎链球菌	12 (16.22)	11 (13.58)	23 (14.84)
?	金黄色葡萄球菌	8 (10.81)	12 (15.00)	20 (13.00)
?	溶血性葡萄球菌	6 (8.11 )	6 (7.90)	12 (8.00)
?	合计	74(100.00)	81(100.00)	155(100.00)

表2 2009及2010年革兰阴性菌对常用抗菌药物的耐药率比较[n(%)]

Table 2 Comparison of the drug resistance of the G^－ bacteria against the common antibacterial drug in 2009 and 2010 [n(%)]

抗菌药物类别	2009年			2010年
抗菌药物类别	肺炎克雷伯菌(n＝17)	大肠埃希菌(n＝14)	铜绿假单胞菌(n＝7)	肺炎克雷伯菌(n＝18)	大肠埃希菌(n＝13)	铜绿假单胞菌(n＝10)
青霉素	15(88.24)	12(85.71)	6(85.71)	17(94.44)	13(100.00)	9 (90.00)
氨苄西林	16(94.12)	13(92.86)	6(85.71)	17(94.44)	13(100.00)	10(100.00)
阿莫西林	15(88.24)	12(85.71)	5(71.43)	16(88.89)	12 (92.31)	9 (90.00)
头孢唑林	9(52.94)	8(57.14)	4(57.14)	12(66.67)	9 (69.23)	8 (80.00)
氨曲南	8(47.06)	7(50.00)	4(57.14)	11(61.11)	9 (69.23)	7 (70.00)
头孢他啶	9(52.94)	11(78.57)	3(42.86)	11(61.11)	12 (92.31)	6 (60.00)
头孢噻肟	7(41.18)	7(50.00)	2(28.57)	9(50.00)	8 (61.54)	3 (30.00)
克拉维酸/头孢噻肟	2(11.76)	3(21.43)	0 (0.00)	2(11.11)	3 (23.08)	0 (0.00)
克拉维酸/头孢他啶	2(11.76)	0 (0.00)	0 (0.00)	3(16.67)	0 (0.00)	0 (0.00)
亚胺培南	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)

表2 2009及2010年革兰阴性菌对常用抗菌药物的耐药率比较[n(%)]

Table 2 Comparison of the drug resistance of the G^－ bacteria against the common antibacterial drug in 2009 and 2010 [n(%)]

抗菌药物类别	2009年			2010年
抗菌药物类别	肺炎克雷伯菌(n＝17)	大肠埃希菌(n＝14)	铜绿假单胞菌(n＝7)	肺炎克雷伯菌(n＝18)	大肠埃希菌(n＝13)	铜绿假单胞菌(n＝10)
青霉素	15(88.24)	12(85.71)	6(85.71)	17(94.44)	13(100.00)	9 (90.00)
氨苄西林	16(94.12)	13(92.86)	6(85.71)	17(94.44)	13(100.00)	10(100.00)
阿莫西林	15(88.24)	12(85.71)	5(71.43)	16(88.89)	12 (92.31)	9 (90.00)
头孢唑林	9(52.94)	8(57.14)	4(57.14)	12(66.67)	9 (69.23)	8 (80.00)
氨曲南	8(47.06)	7(50.00)	4(57.14)	11(61.11)	9 (69.23)	7 (70.00)
头孢他啶	9(52.94)	11(78.57)	3(42.86)	11(61.11)	12 (92.31)	6 (60.00)
头孢噻肟	7(41.18)	7(50.00)	2(28.57)	9(50.00)	8 (61.54)	3 (30.00)
克拉维酸/头孢噻肟	2(11.76)	3(21.43)	0 (0.00)	2(11.11)	3 (23.08)	0 (0.00)
克拉维酸/头孢他啶	2(11.76)	0 (0.00)	0 (0.00)	3(16.67)	0 (0.00)	0 (0.00)
亚胺培南	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)

表3 2009及2010年革兰阳性菌对常用抗菌药物的耐药率比较[n(%)]

Table 3 Comparison of the drug resistance of the G^＋ bacteria against the common antibacterial drug in 2009 and 2010 [n(%)]

抗菌药物类别	2009年		2010年
抗菌药物类别	肺炎链球菌(n＝12)	金黄色葡萄球菌(n＝8)	肺炎链球菌(n＝11)	金黄色葡萄球菌(n＝12)
青霉素	10(83.33)	8(100.00)	11(100.00)	10(83.33)
氨苄西林	9(75.00)	7 (87.50)	10 (90.91)	9(75.00)
阿莫西林	8(66.67)	5 (62.50)	10 (90.91)	9(75.00)
头孢唑林	7(58.33)	6 (75.00)	8 (72.73)	9(75.00)
氨曲南	7(58.33)	5 (62.50)	4 (36.36)	7(58.33)
头孢他啶	5(41.67)	4 (50.00)	5 (45.45)	5(41.67)
头孢噻肟	5(41.67)	3 (37.50)	4 (36.36)	6(50.00)
克拉维酸/头孢噻肟	4(33.33)	4 (50.00)	6 (54.55)	7(58.33)
克拉维酸/头孢他啶	7(58.33)	2 (25.00)	2 (18.18)	3(25.00)
亚胺培南	0 (0.00)	0(0.00)	0(0.00)	0 (0.00)

表3 2009及2010年革兰阳性菌对常用抗菌药物的耐药率比较[n(%)]

Table 3 Comparison of the drug resistance of the G^＋ bacteria against the common antibacterial drug in 2009 and 2010 [n(%)]

抗菌药物类别	2009年		2010年
抗菌药物类别	肺炎链球菌(n＝12)	金黄色葡萄球菌(n＝8)	肺炎链球菌(n＝11)	金黄色葡萄球菌(n＝12)
青霉素	10(83.33)	8(100.00)	11(100.00)	10(83.33)
氨苄西林	9(75.00)	7 (87.50)	10 (90.91)	9(75.00)
阿莫西林	8(66.67)	5 (62.50)	10 (90.91)	9(75.00)
头孢唑林	7(58.33)	6 (75.00)	8 (72.73)	9(75.00)
氨曲南	7(58.33)	5 (62.50)	4 (36.36)	7(58.33)
头孢他啶	5(41.67)	4 (50.00)	5 (45.45)	5(41.67)
头孢噻肟	5(41.67)	3 (37.50)	4 (36.36)	6(50.00)
克拉维酸/头孢噻肟	4(33.33)	4 (50.00)	6 (54.55)	7(58.33)
克拉维酸/头孢他啶	7(58.33)	2 (25.00)	2 (18.18)	3(25.00)
亚胺培南	0 (0.00)	0(0.00)	0(0.00)	0 (0.00)

表4 本组检出前5位细菌菌株中产ESBLs菌检出情况[n(%)]

Table 4 The detection rates of the producing ESBLs among top five bacteria strains [n(%)]

病原菌	n	产ESBLs菌检出率
肺炎克雷伯菌	35	17(48.57)
大肠埃希菌	27	8(29.63)
肺炎链球菌	23	6(26.09)
金黄色葡萄球菌	20	5(25.00)
铜绿假单胞菌	17	4(23.53)
合计	122	40(32.79)

表4 本组检出前5位细菌菌株中产ESBLs菌检出情况[n(%)]

Table 4 The detection rates of the producing ESBLs among top five bacteria strains [n(%)]

病原菌	n	产ESBLs菌检出率
肺炎克雷伯菌	35	17(48.57)
大肠埃希菌	27	8(29.63)
肺炎链球菌	23	6(26.09)
金黄色葡萄球菌	20	5(25.00)
铜绿假单胞菌	17	4(23.53)
合计	122	40(32.79)

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