上呼吸道感染患儿咽部病原菌分布及耐药性分析

目的了解天津滨海地区儿童上呼吸道感染病原菌情况及耐药性，以便指导临床合理用药。方法对2012年1月至2013年4月天津市滨海新区汉沽中医医院住院儿科1022例上呼吸道感染儿童咽拭子标本进行培养及鉴定。采用法国ATB自动细菌鉴定仪及MIC药敏板进行细菌鉴定和药敏试验，β-内酰胺酶试验采用头孢硝噻吩纸片法，耐甲氧西林金黄色葡萄球菌（MRSA）采用头孢西丁纸片法检测。结果检出病原菌296株，其中金黄色葡萄球菌、肺炎链球菌及流感嗜血杆菌检出率分别为13. 70%、5. 97% 、5. 19%，分列前三位。金黄色葡萄球菌对常用抗菌药物耐药率为苯唑西林30. 0%、青霉素95. 7%、红霉素80. 0%、左氧氟沙星4. 3%，MRSA占30. 0% （42/140）、;肺炎链球菌对常用抗菌药物耐药率为青霉素9. 84%、红霉素54. 1%、克林霉素52.5%、左氧氟沙星3. 3% ;流感嗜血杆菌对常用抗菌药物耐药率为氨苄西林34. 0%、阿奇霉素0%、左氧氟沙星0%，复方新诺明56. 6%、头孢呋辛3. 8%、阿莫西林/克拉维酸5. 7%。结论天津滨海地区儿童上呼吸道感染病原菌分布广泛，检出致病菌有一定的耐药率，临床应重视根据病原菌感染情况及药敏试验结果，进行耐药性监测和合理用药。

Analysis of pathogenic bacteria and antibiotic resistance in pharyngeal secretion of upper respiratory tract infection children

Objective To study the pathogen distribution and antibiotic resistance in upper respiratory tract infection children in Tianjin Binhai, guide clinical treatment. Methods A total of 1022 samples from June 2012 to March 2013 inpatient pediatric upper respiratory tract infection children throat swab specimens for culture. ATB identification System and MIC susceptibility assay were used forbacterial identification and susceptibility testing, β-lactamase test using nitrocefin disk, （MRSA） using cefoxitin. Results 296 kinds ofpathogens were detected,including Staphylococcus aureus,Streptococcus pneumoniae and Haemophilus influenzae ; the rate of detected were13.70%,5.91% and 5. 19%,respectively. The resistance rates of Staphylococcus aureus to oxacillin was 30. 0% , to penicillin was95.1% , to erythromycin was 80. 0%,to levofloxacin was 4. 3%,MRSA was 30. 0% （42/140） ; The resistance rates of Streptococcuspneumoniae to penicillin was 9. 84% , to erythromycin was 54. 1% , to clindamycin was 52. 5% , to levofloxacin was 3. 3% ; The resistance rates of Haemophilus influenzae to ampicillin was 34. 0%,to azithromycin was 0%,to levofloxacin was 0% , to cotrimoxazole was56. 6%,to cefuroxime was 3. 8%,to amoxicillin/clavulanic acid was 5. 7% . Conclusion The pathogens in upper respiratory tract infection children in Tianjin Binhai Pathogenic bacteria are widely distributed, the resistance rates with an increasing trend, clinical attention should be paid according to pathogen infection and susceptibility test results in resistance surveillance and rational drug use.