婴幼儿重症医院获得性肺炎病原学分析

Analysis of Etiology of Severe Hospital-Acquired Pneumonia in Infants

目的了解3岁以下重症医院获得性肺炎(HAP)患儿深部痰液病原菌分布及其耐药情况。方法选取2007年1月-2008年12月在深圳市儿童医院PICU住院的41例婴幼儿重症HAP患儿,采集患儿深部呼吸道痰液,并对其进行细菌培养和药敏试验。结果 41例HAP患儿中,38例(92.7%)痰培养阳性,检出菌落8种,共分离48株。其中革兰阴性菌43株,革兰阳性菌1株,真菌4株。革兰阴性菌以肺炎克雷伯杆菌、铜绿假单胞菌和大肠埃希菌为主,对氨苄西林、头孢唑啉、头孢曲松、复方磺胺甲唑、呋喃妥因、头孢吡肟、头孢替坦、头孢他啶耐药率较高,对亚胺培南、环丙沙星、哌拉西林/他唑巴坦、左旋氧氟沙星、阿米卡星耐药率低。肺炎克雷伯杆菌和大肠埃希菌产超广谱β内酰胺酶阳性率分别为78.57%和77.78%。革兰阳性菌1株,为金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌阳性。真菌4株,均为酵母菌,其中2株对依曲康唑耐药。结论婴幼儿重症HAP主要是由细菌感染引起,以革兰阴性菌为主,依次为肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌,产超广谱β内酰胺酶阳性率高。对常见第二、三代头孢耐药率高,初始经验用药宜选用哌拉西林/他唑巴坦和碳青霉烯类抗生素。

Objective To understand the survey of deep sputum pathogen distribution in children within 3 years old with severe hospital-acquired pneumonia（HAP） and its antibiotic resistance.Methods Forty-one infants with severe HAP were enrolled,who were hospitalized in Pediatric Intensive Care Unit of Shenzhen Children′s Hospital from Jan.2007 to Dec.2008.sputum specimen were collected from the lower respiratory tract for bacterial culture and sensitivity test,and the results were analyzed.Results Sputum culture of 38 cases（92.7%） were positive in 41 children with severe HAP patients,8 type bacteria were detected and 48 strains were isolated,including 43 cases gram-negative bacilli,1 case gram-positive cocci,4 cases fungi.The common gram-negative bacteria were klebsiella pneumoniae,pseudomonas aeruginosa and escherichia coli.Most of them were resistant to ampicillin,cefazolin,ceftriaxone,trimethoprim＋sulfamethoxazole,nitrofurantoin,cefepime,cefotetan,ceftazidime,and were sensitive to imipenem,ciprofloxacin,piperacillin/tazobactam,levofloxacin,amikacin.The positive rate of extended-spectrum beta-lactamase（ESBLs）-producing strains of klebsiella pneumoniae and escherichia coli were 78.57% and 77.78%.One gram-positive bacterium was staphylococcus aureus,which were methicillin-resistant staphylococcus aureus-positive.Four cases fungi were yeasts,2 cases of which were resistant to itraconazole.Conclusions Bacterium was the major organism in infants with severe HAP and the most common organism identified was gram-negative bacilli.Followed by klebsiella pneumoniae,pseudomonas aeruginosa,escherichia coli.Most of them were ESBLs-positive and resistance to second and third generation cephalosporin.The initial empirical antibiotics administration should be chosen piperacillin/tazobactam and carbapenem.