Changes of pathogens and drug resistance in community-acquired pneumonia in children

Abstract

Objective To analyze the changes of pathogens and drug resistance in communityacquired pneumonia ( CAP ) in children to provide guidence for optimal uses of antibiotics.Methods Sputum samples from 4806 children with CAP at seven hospitals were cultured.Bacterial strains were isolated and identified by API or the MicroScan WalkAway 40 SI.Antimicrobial susceptibility was tested;and ESBLs,AmpC,and MRS were examined according to the criteria of NCCLS guidelines.The WHONET 5.0 software was used for analysis of antimicrobial resistance.Results Among 1127 isolated pathogenic strains,628 ( 55.7％ )were gram-negative,mostly Klebsiella pneumoniae,followed by Escherichia coli,466 ( 41.4％ )were gram-positive cocci,mostly Streptococcus penumoniae,followed by Staphylococcus aureus; 33 ( 2.9％ )were Candida.Gram-negative bacilli had the highest resistant rate ( 91.4％ - 94.3％ )to ampicillin and the first generation of cephalosporins,but is susceptible to imipenem.The rates of producing ESBLs and AmpC were 58.8％ and 19.8％ for Klebsiella pneumonia and 55.0％ and 12.3％ for Escherichia coli,respectively.Gram-positive cocci had the highest resistant rate ( 93.3％ - 100.0％ ) to penicillin,oxacillin sodium,and erythromycin.Conclusions The main pathogens for CAP in children were gramnegative strains and gram-positive cocci.Due to the frequent uses of β-lactams and macrolides in the department of pediatrics,pathogens produce ESBLs and AmpC highly.The pathogens have severe drug resistance to antibiotics.It is of importance for sputum cultures and testing antimicrobial resistance. Key words: Children; Community-acquired pneumonia; Pathogens; Drug resistance; Sputum cultures