目的 分析本地区婴幼儿下呼吸道感染常见病原菌及其对常用抗生素的耐药性,为临床药物治疗提供有价值的参考.方法 2009年1月至2011年12月在深圳市龙岗区妇幼保健院儿科住院的6 371例婴幼儿下呼吸道感染患儿喉腔深部分泌物经德国赛默飞世尔科技公司CO2培养箱细菌培养后,采用法国梅里埃ATB半自动细菌分析仪进行细菌鉴定及药物敏感试验,同时进行超广谱β-内酰胺酶(Extended spectyumβ lactamase,ESBLs)菌株检测.结果 6 371例婴幼儿下呼吸道感染患儿共分离培养出病原菌886株,阳性率为13.91％;培养出的886株病原菌中肺炎克雷伯杆菌阳性率最高244例,占27.54％,其他依次为大肠埃希菌161例(18.17％)、金黄色葡萄球菌142例(16.03％)、肺炎链球菌123例(13.88％)、不动杆菌60例(6.77％)、凝固酶阴性葡萄球菌46例(5.19％)、产气肠杆菌19例(2.14％)、阴沟肠杆菌19例(2.14％)、铜绿假单胞菌18例(2.03％)、变形杆菌10例(1.13％)、沙门菌3例(0.34％)、志贺氏菌2例(0.23％)、其他病原菌39例(4.40％).244株肺炎克雷伯菌产ESBLs株116株,检出率为47.54％; 161株大肠埃希菌中产ESBLs株为67株,检出率为41.61％.1～3个月龄的小婴儿组及4～12个月龄的婴儿组病原菌以肺炎克雷伯杆菌、大肠埃希菌革兰氏阴性杆菌和金黄色葡萄球菌为主,13～36个月龄的幼儿组病原菌以肺炎球菌培养阳性率最高.肺炎克雷伯菌对阿莫西林、哌拉西林、替卡西林、头孢噻吩、头孢呋辛的耐药率分别为97.95％、52.87％、93.44％、60.66％、52.05％;大肠埃希菌对阿莫西林、哌拉西林、替卡西林、头孢噻吩、头孢呋辛的耐药率分别为80.12％、76.40％、80.12％、75.78％、63.35％;金黄色葡萄球菌对青霉素和红霉素的耐药率分别是92.2％、54.61％;凝固酶阴性葡萄球菌对青霉素、红霉素和苯唑西林的耐药率分别为80.43％、54.35％、50.00％;而肺炎球菌对青霉素、苯唑西林和头孢西丁的耐药率分别为58.54％、62.60％、49.59％,对头孢曲松耐药率较低(7.32％).结论 肺炎克雷伯杆菌已成为本地区婴儿期社区下呼吸道感染主要的病原菌,而肺炎球菌主要存在于＞1岁的幼儿.对于＜1岁的患儿尤其是3个月龄内的小婴儿更应考虑革兰氏阴性杆菌的感染,必要时可慎重选用含β-内酰胺酶抑制剂的复合抗生素或碳青酶烯类抗生素.%Objective To investigate the bacterial distribution and resistance to antibiotics with low-respiratory tract infections for this area, so as to provide reference and guidance for the rational use of antibiotics. Methods We have tested 6 371 secretion specimens from deep larynx of the hospitalized infants. Firstly, the specimens were tested germiculture by CO2 -culture box (from Thermo Fisher Scientific Company of Germany). Secondly, the identification and drug sensitivity of the bacteria were tested by ATB semiautomatic bacteria analyzer (from bioMerieux of France) from January 2009 to December 2011. Results A total of 886 pathogenic strains were detected, with a detection rate of 13.91% (886/6371), including 244 strains of Klebsiellapneumonia (244/886, 27.54%), 161 strains of Escherichia col-li (161/886, 18.17%), 142 strains of Staphylococcus aureus (142/886, 16.03%), 123 strains of Streptococcus pneumoniae (123/886, 13.88%), 60 strains of Acinetobacter baumannii (60/886, 6.77%), 46 strains of coagulase negative staphylococcus (46/886) 5.19%, Enterobacter aerogenes (19/886) 2.14%; Aerobacter cloacae (19/886, 2.14%), 18 strains of Pseu-domonas aeruginosa (18/886, 2.03%), 10 strains of Bacillus proteus (10/886, 1.13%), 3 strains of Saimonella (3/886, 0.34%), 2 strains of Schmitz baciclus (2/886, 0.23%) and 39 other pathogens (39/161, 4.40%). 116 of the 244 strains of Klebsiella pneumonia (47.54%) and 67 of the 161 strains of Escherichia coli (41.61%) were detected with ESBLs. The main pathogens were Klebsiella pneumonia, Escherichia coli and Staphylococcus aureus for the 1~3 months old group and 4-12 old group, while that was Streptococcus pneumoniae for the 13~36 months old group. The rate of drug resistance of Klebsiella pneumonia to amoxicillin, piperacillin, ticarcillin, cafalotin and cefuroxime was 97.95%, 52.87%, 93.44%, 60.66% and 52.05%, respectively. The rate of drug resistance of Escherichia colli to amoxicillin, piperacillin, ticarcillin, cafalotin and cefiiroxime was 80.12%, 76.40%, 80.12%, 75.78% and 63.35%, respectively. The rate of drug resistance of Staphylococcus aureus to penicilin and erythromycin was 92.2% and 54.61%, respectively. The rate of drug resistance of Coagulase negative staphylococcus to penicillin, erythromycin and oxacillin was 80.43% , 54.35% and 50.0%, respectively. The rate of drug resistance of Micrococcus pneumoniae to penicilin, oxacillin and cefoxitin was 58.54%, 62.60%, 49.59%, respectively, and that to ceftriaxone was significanly lower (7.32%). Conclusion Klebsiella pneumonia is the major pathogenic bacteria in the low-respiratory tract infections for infants for this area, and Streptococcus pneumoniae is the major pathogenic bacteria for young children (13-36 months old). Klebsiella pneumonia resisted to almost beta-lactams. The infection of Gram negative bacteria was the primary consideration to the infants younger than 1 year old, especially that below 3 months old. Antibiotics with beta-lactamase inhibitor and carbo-penems antibiotics should be used carefully and rationally.
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