The Detection Of Bacteria And Reisistance In Children Lower Respiratory Infections

Objective:Lower respiratory infections(LRTIs) in childrenis the most common disease,with the high disease rate,which alsois the main cause of children to be in hospital.The common etiologyof LRTIs includes bacteria, virus, atypical pathogen (Mycoplasma,Chlamydia, Legionella Pneumophila), fungus andprotozoon now.The bacteria which causes the disease is to befrequent.With the antibiotic being used extensively and the livingenvironment been changed,the pathogenic bacteria has beendiversified very much. The physiological microbial populationchanges to be pathogenic bacteria in exceptional condition,which is resistant to many kinds of antibiotics. For this reason,clinicians are meeting much difficulties in diagnosis andhealing. Our country has a vast territory,there is great differencein different region,so do their economical and healthy condition.Different etiology has different therapeutic method. So earlydefinite diagnosis in etiology has great significance, which alsois the guarantee for proper appllication of antibiotics.Methods:Bacterial identification and susceptibility testwere done for 442 sputum specimens of pediatric patients withlower respiratory tract infections in my hospital from Oct.2007to Dec.2008.Making statistical analysis according to the results. Results:1 In 442 cases,removing 2 disqualifications,187 srains were separated from the 440 sputum samples,the total positive rate was 42.5%.The chief pathogens were Gram negative bacteria which included Escherichia coli, Klebsiella pneumonia, Pseu-domonas aeruginosa, Enterobacter cloacae , Acinetobacter, Serratia and so on, accounting for 79.1%.Gram positive bacteria which included Staphylococcus aureus, Staphylococcus epider-midis and Streptococcus bovis for 20.9%.The Gram negative bacteria was the main pathogenic bacteria.2 the results of antibiotic susceptibility test: (1)For Escherichia coli, the rates of sensitivity to piperacil-lin/tazobactam,cefoxitin,cefepime,cefotaxime,ceftrixo-ne,ceftazidime, aztreonam,imipenem,meropenem,ciprofloxacin, gen-tamicin, amikacin, tetracycline, Levofloxacin and SMZ-TMP were 72.2%,88.9%, 57.4%,27.8%, 31.5%,31.5%, 48.1%,100%, 100%,57.4%,72.2%,88.9%,27.8%,64.8% and 85.2%, respect- ively, and the rates of resistance were 20.4%,3.7%,31.5%, 72.2%,68.5%,57.4%,22.2%,0,0,38.9%,27.8%,11.1%,72.2%,35.2% and 11.1%. ESBLs-producing strains of Escherichia coli and Klebsiella pneumonia were 92.6% and 86%.For Klebsiella pneumonia, the rates of sensitivity to piperacillin/tazobac- tam,cefoxitin, cefepime,cefotaxime, ceftrixone, ceftazidime, az-treonam,imipenem,meropenem, ciprofloxacin,gentamicin,am- ikacin,Levofloxacin and SMZ-TMP were 68.6%,80%, 54.3%, 25.7%,28.6%,51.4%,34.2%,100%,100%,60%,60%,74.3%,80% and 48.6%,and the rates of resistance were 8.5%,20%,28.6%, 65.7%,62.8%,40%,53.3%,0, 0,28.6%,28.6%, 17.1%, 8.6% and 40%.For Enterobacter cloacae, the rates of sensitivity to pipera- cillin/tazobactam,cepoperazon/sulbactam, aztreonam, imipenem, meropenem, ciprofloxacin, gentamicin,amikacin, tetracycline, Levofloxacin and SMZ-TMP were70.6%,77.8%,54.7%, 100%, 100%,78.7%,76.4%,78.7%,11.8%,33.5% and 78.7%, which was resistant highly to cefepime,cefotaxime, ceftrixone, ceftazidime. For Serratia , the rates of sensitivity to cefepime was 100%. Klebsiella planticola was sensitive to imipenem and meropenem.(2)For Pseudomonas aeruginosa,the rates of sensitivity to imipenem, meropene, SMZ-TMP, ceftazidime, piperacillin tazobactam,cefepime,ciprofloxacin,gentamicin and amikacin were 100%,100%,95%,90%,80%,65%,50% and 60%.(3)For Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus bovis, the rates of sensitivity to vanco-mycin, teicoplanin and ciprofloxacin all were 100%,whichwere resistant to erythromycin and Clindamycin.3 There existed differences in disposition of season. The difference of years of age disposition was significant.In thedisposition of the course of diseases,there were remarkabledifferences between the infected children above 3 days andthe children from 5 to 14 days.In the disposition of season,gram negative bacteria were in the majority of infectious bacteria and their constituent ratio was comparatively largerin spring and winter. Conclusions: Gram negative bacteria was the major pathogenic bacteria in LRTIs of the children,and the resista-nce of the different types of bacteria was various to antibiotics.Multi-drug resistance of Escherichia coli,Klebsiella pneumoniaand Nonfermenters becomed a serious problem. The rates ofESBLs producing by Escherichia coli,Klebsiella pneumonia were high.Gram positive bacteria was resistant to erythromy-cin and Clindamy,but was sensitive to vancomycin,teicoplanin and ciprofloxacin.The disposition of season,years of age and the course of disease were evident. The investigation contributes to instruction of clinical therapy,appropriate useof antibiotics, and reducing the formation of drug resistant strains.