儿童细菌性重症肺炎病原菌的临床分析

A Clinical Analysis of Bacterial Pathogens of Severe Pneumonia in Children

目的:对儿童细菌性重症肺炎的病原菌及药物敏感结果进行分析,以指导临床合理使用抗生素。方法:对重庆医科大学附属儿童医院重症监护室(PICU)2005年1月～2008年12月儿童细菌性重症肺炎的病原菌及药敏结果进行回顾性分析。结果:166例重症肺炎患儿中痰菌培养阳性者70例,检出率为42.16%。共检出病原菌102株,其中革兰阴性杆菌61株,占59.8%,以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主;革兰阳性球菌51株,占40.2%,以金黄色葡萄球菌、肺炎链球菌为主。药敏结果显示各种病原菌对青霉素类及头孢类抗生素有较高的耐药率,而对亚胺培南-西司他丁(泰能)有较高的敏感率,达80%以上,革兰阳性球菌对万古霉素敏感率达85%以上。结论:革兰阴性菌是小儿重症肺炎的主要致病菌,故重症肺炎早期治疗的抗生素应选用碳青霉烯类、第四代头孢菌素和加有β-内酰胺酶抑制剂的第三代头孢菌素。

Objective：To analyze the bacterial pathogens and the antimicrobial susceptibility of severe pneumonia in children and to provide a rational use of antibiotics. Methods： Bacterial pathogens and the antimicrobial susceptibility of severe pneumonia in children hospitalized in PICU of Chongqing Children＇s Hospital from Jan. 2005 to Dec. 2008 were retrospectively analyzed. Results： The positive rate of sputum bacterial cultures of severe pneumonia was 42. 16% （ 70/166 ） and 102 strains were isolated. Among the 102 isolated strains, 61 （59.8%） were Gram-negative bacilli, Gram-positive cocci 51 （40.2%）. The most common gram-negative bacilli were Klebsiella pneumonia, escheriehia coli and pseudomonas aeruginosa. The common gram-positive cocci were Staphylococcus aureus and Streptococcus pneumoniae. The antimicrobial susceptibility test showed that various pathogens had high resistant rate to penieillins and cephalosporins, but sensitive to Imipenem-Cilastatin （Tienam） with a sensitive rate of 80%. The sensitive rate of the gram-positive cocci to Vancomycin was more than 85%. Conclusions： Gram-negative bacterium is the main pathogen of severe pneumonia in children. So the combined therapy of carbapenems, fourth generation cephalosporin and third generation cephalosporins with β-lactamase-producing enzyme inhibitors is suitable for the early treatment of severe pneumonia.