重症呼吸道合胞病毒肺炎临床特点及抗菌药物使用分析

Clinical characteristics and use of antibiotics in severe respiratory syncytial virus pneumonia

目的总结儿童重症呼吸道合胞病毒(RSV)肺炎的临床特点及抗菌药物使用情况。方法回顾性分析2005年1月—2009年12月住院的重症RSV肺炎患儿的临床和病原学资料,调查抗菌药物使用情况。结果因RSV感染住院共4 189例,符合重症肺炎诊断标准的有306例(7.3%),其中男214例,女92例,年龄8 d～4岁,6个月以内占81.0%。217例(70.9%)合并有基础疾病,以先天性心脏病最多见,其次为早产和低出生体质量、营养不良及神经系统疾病。306例行痰液病原学检测,51例行血培养,结果102例(33.3%)合并感染。从痰液中检出病原体129株,其中细菌114株,以革兰阴性菌最多占69.0%;其次为革兰阳性菌占19.4%;3例血培养阳性。所有患儿均使用抗菌药物治疗,以头孢菌素类最多达88.9%;单药治疗占63.4%,二联使用占35.0%;用药时间<1周68例(22.2%),～2周168例(54.9%)。治愈217例,好转81例,未愈自动出院7例,死亡1例。结论 RSV是儿童重症肺炎最主要的病毒病原,重症RSV肺炎主要见于6个月以下婴儿,70.9%合并有基础疾病;33.3%合并感染,以革兰阴性菌最常见;88.9%使用头孢菌素治疗,多为单药治疗,疗程1～2周。

Objectives To investigate the clinical characteristics and use of antibiotics in severe respiratory syncytial virus （RSV） pneumonia in children. Methods Retrospective analysis of clinical and etiological data was performed in children with severe RSV pneumonia admitted to our hospital from January 2005 to December 2009. Results Among total of 4189 cases of RSV infection, 306 patients （7.3%） met the diagnostic criteria of severe pneumonia; 214 were male and 92 were female, aged from 8 days to 4 years old. The proportion of patients younger than 6 months was 8110%. Overall, 161 （52.6%） had respiratory failure, 22 （7.2%） developed heart failure, 7 （2.3%） had toxic encephalopathy, 3 （1.0%） developed sepsis and multiple organ dysfunction, 1 had septic shock and alimentary tract hemorrhage. 126 （41.2%） were admitted to ICU, of which 36 （11.8%） were applied mechanical ventilation. Underlying diseases were observed in 217 （70.9%） patients, they are congenital heart disease, followed by premature birth and low birth weight, malnutrition, and nervous system disease. All cases were performed sputum pathogen detections and 51 were also got blood cultures. Combined pathogenic infection were found in 102 cases （33.3%）. In sputum 129 strains of pathogens were identified, of which 114 strains were bacteria, the predominant one was Gram-negative bacteria （69.0%）, followed by Gram-positive bacteria （19.4%）; blood culture were positive in 3 cases. All patients were treated with antibiotics, the use of cephalosporins utilization was up to 88.9%. The use of one antibiotic accounted for 63.4%, while the combination of two antibiotics accounted for 35.0%. Using of antibiotics in 68 cases （22.2%） was less than one week, 168 （54.9%） were between one to two weeks. The outcome are 217 cases cured, 81 improved, and 1 died. Conclusions RSV was the most important pathogenic virus in severe pneumonia in children. Severe RSV pneumonia were mainly seen in infants under 6 months and the underlying diseases were found in 70.9% of cases; More than half of children had respiratory failure and 33.3% of them had combined pathogenic infection, and Gram-negative was the most common bacteria. Cephalosporin treatment was used in 88.9% of case, The use of single antibiotics for 1 - 2 weeks was the usual choice.