胃液细菌培养在重症SIRS患儿的临床意义

The clinical significance of the gastric fluid bacterial culture in the children suffering severe Systemic Inflammatory Response Syndrome(SIRS)

目的初步掌握重症全身炎症反应综合征(即重症SIRS)患儿的胃肠道菌群变化规律,为临床提供理论依据。方法重症SIRS组43例,早期SIRS组选择符合早期SIRS诊断的普通型肺炎患儿20例,分别进行胃液细菌培养、血培养。结果重症SIRS组胃液细菌培养、血培养的阳性率明显高于早期SIRS组;两组间胃液细菌培养结果、血培养结果均有明显差别;<6个月的小婴儿胃液细菌培养阳性率高于其他年龄组;阳性菌中约1/3的菌株ESBLs阳性。结论(1)重症SIRS组患儿在胃肠道细菌移位及MODS发生之前,可能已经发生了胃肠道内菌群的严重失调,6个月以内的小婴儿更为多见;(2)移位的细菌主要为肠道固有定植菌和条件致病菌;(3)重症SIRS患儿的脓血症可能与胃肠道细菌移位有关;(4)阳性菌中约有1/3左右的菌株对多种常用抗生素有不同程度的耐药性。

Objective To investigate the changes of gastric fluid microbial population in children suffering severe SIRS.Methods Forty-three inpatient cases of severe SIRS children in the pediatric intensive care unit (PICU) of the second affiliated hospital of China Medical University were enrolled.The twenty children that were suffering mild pneumonia and consistented with the diagnosis of early SIRS.We collected the gastric fluid and blood of the patients,carried out bacterial cultures.Results The positive rate of gastric fluid bacterial culture and hemoculture of the severe SIRS group were significantly higher than those of early SIRS group.The positive rate of gastric fluid bacterial culture of the infant younger than six months was higher than that of the others. About thirty percent of positive strain produced extended spectrum β lactamases(ESBLs).Conclusion (1) Before the translocation of enterobacteria and the onset of multiple organ dysfunction syndrome (MODS),there were severe imbalance of gastrointestinal tract microbial population in gastrointestinal tract in the severe SIRS children,especially in the infant younger than six months.(2)The main translocated bacteria were inherent entero-permanent planting population and conditional pathogenic bacteria.(3)The sepsis syndrome of SIRS children may be related to the bacteria translocation of gastrointestinal tract.(4) The thirty percent strain that produced ESBLs was resistant to most antibiotics except Tienam and Mepem.