儿童先天性心脏病合并下呼吸道感染痰培养及药敏结果分析

Analysis of sputum culture and sensitivity for children with congenital heart disease and lower respiratory tract infection

目的探讨儿童先天性心脏病(先心病)合并下呼吸道感染痰培养阳性率、病原菌分布和药敏试验结果,为临床防治感染提供选药依据。方法回顾性分析该院儿科和心血管外科收治的87例先心病合并下呼吸道感染患儿的痰培养和药敏试验报告。结果痰培养阳性59例,阳性率67.82%,阳性率高。检出菌种20种,G-菌13种,G+菌6种,霉菌1种。痰培养阳性样本以G-菌为主,占57.65%;病原菌种类多,交叉耐药多,敏感药物选择面窄,耐药菌株多;在药物敏感度上有明显优势的药物相对较少。结论先心病合并下呼吸道感染的痰培养以G-菌为主,应选择对G-菌敏感的抗生素为主,并应酌情辅用对G+菌敏感的联合治疗方案;因儿童年龄及生理特点,临床用药限制多,耐药菌株多,表明儿童临床药物选择面较成人更窄,采用痰培养结果指导临床合理用药非常必要。

Objective To identify the distribution and drug resistance of common and special pathogens in the patients with congenital heart disease and lower respiratory tract infection for providing evidence of clinical anti-infection therapy. Methods To retrospectively analyse the results of 87 sputum cultures of patients with congenital heart disease and lower respiratory tract infection in our department and department of cardiovascular surgery. Results In 87 specimens, 59 sputum cultures were positive, and the positive rate was 67.82%. 20 pathogens were proven. Among all pathogens in low respiratory tract infection,13 were gram-negative bacteria, accounting for 57.65 %, and 6 were gram-positive bacteria, and only one was fungus. Cross drug resistance was common and the sensitive drug was restricted. Above all, there was not a drug with higher sensitivity to most of the pathogens. Conclusion In the patients with congenital heart disease and lower respiratory tract infectlon,gram-negative bacteria were the most common pathogens, so we should choose antibiotics which were sensitive to gram-negative bacteria supplemented by combination therapy with drug sensitive to gram-positive bacteria. As for children, it is restricted to choose the ideal antibiotics, appropriate sputum cultures could provide important information to choose reasonable antibiotics.