摘要
目的对小儿社区获得性肺炎临床常见的革兰阴性杆菌的耐药性及体外抗菌活性进行分析研究。方法采用VITEK-32全自动微生物鉴定仪进行细菌鉴定和药敏试验，最小抑菌浓度（MIC）应用微量琼脂稀释法测定，超广谱β内酰胺酶（ESBLs）检测采用双纸片扩散法。结果小儿社区获得性肺炎深部痰标本1029例分离出的G杆菌中，分离率位于前5位的菌为肺炎克雷伯菌172株、大肠埃希菌163株、鲍曼不动杆菌71株、黏质沙雷菌70株，铜绿假单胞菌45株。15种抗菌药物对此5种革兰阴性杆菌的体外活性中，亚胺培南对肠杆菌科菌肺炎克雷伯菌、大肠埃希菌和黏质沙雷菌100．00％敏感，MIC50和MIC90均为4ug／ml。对非发酵菌鲍曼不动杆菌和铜绿假单胞菌敏感率为80．00％以上，MIC50和MIC90为4μg／ml和16μ／ml；β内酰胺类药物包括第三、四代头孢菌素的耐药率都相对较高，尤其第三代头孢曲松对黏质沙雷菌和铜绿假单胞菌的耐药率分别高达92．86％和100．00％；哌拉西林／他唑巴坦对5种G-杆菌的敏感率都较高，在80．00％～100．00％之间；其余抗生素在儿童应用很少，但也有一定的耐药性。主要产ESBLs的菌株肺炎克雷伯菌和大肠埃希菌ESBLs的发生率分别为42．44％和53．99％。结论小儿社区获得性肺炎标本中分离的各种G杆菌的耐药性均不尽相同，对本地区常见细菌的耐药性进行监测具有重要意义。
Objective To study the antibacterial activity in vitro of clinical isolates of gram negative bacilli in children with community-acquired pneumonia. Methods Identification of bacteria and drug susceptibility test were performed with VITEK-32 automatic microbiological analyzer. The minimal inhibitory concentration （MIC） was determined by agar microdilute test. Extended spectrum β lactamases （ESBLs）-producing strains were confirmed by double disk diffusion method. Results 521 gram negative bacilli strains were isolated from 1 029 specimens from children with community-acquired pneumonia. The isolated gram negative bacilli strains in order were Klebsiella pneumoniae （172 strains）, Escherichia coli （163 strains）, Acinetobacter baumannii （71 strains）, Serratia marcescens （70 strains） and Pseudomonas aeruginosa （45 strains）. Klebsiella pneumoniae, Escherichia coli and Serratia marcescens were 100.00% sensitive to imipenem, and both MIC50 and MIC90 were 4 μg/ml. The sensitivity rates of Pseudomonas aeruginosa and Acinetobacter baumanii to imipenem were above 80.00%. Their MIC50 was 4 μg/ml and MIC90 was 16 μg/ml. The resistance rates of the third and fourth generation of cefalosporins were relatively higher. Especially, the resistance rate of Serratia marcescens and Pseudomonas aeruginosa to ceftriaxone was 92.86% and 100.00% respectively. The sensitivity rates of these 5 gram negative bacilli strains to piperacillin/tazobactam were between 80.00% and 100.00%. The rest antibiotics were little administrated for children, but there were some drug resistance. ESBLs-producing rate of Klebsiella pneumoniae and Escherichia coli was 42.44% and 53.99 %respectively. Conclusion The drug resistance of each type of gram negative bacilli strains in children with community-acquired pneumonia is not identical. It is vital to monitor the drug resistance of common bacteria in our area.
出处
《国际检验医学杂志》
CAS
2007年第10期872-875,共4页
International Journal of Laboratory Medicine
基金
深圳市医学重点学科建设资助（2005C03）
关键词
儿童
社区获得性肺炎
革兰阴性杆菌
体外抗菌活性
Children
Community-acquired pneumonia
Gram-negative bacilli
Antibacterial activity in vitro
