儿科呼吸机相关性肺炎病原菌分布与耐药性分析

目的通过分析儿科呼吸机相关性肺炎(VAP)的病原菌分布与耐药性情况,探讨VAP的早期抗菌药物治疗措施。方法收集惠东县人民医院儿科重症监护室自2007年1月～2010年12月收治并确诊为呼吸机相关性肺炎患儿65例,分析其痰细菌培养阳性结果,并对病原菌分布与耐药性情况进行统计分析。结果送检痰标本120份,培养结果阳性110例,阳性率91.6%。共检出病原菌138株排除来自同一患者的重复菌株,其中革兰阴性杆菌99株,占72.1%,革兰阳性球菌28株(20.4%);真菌11株(7.9%)。肺炎克雷伯菌最常见,其次为鲍氏不动杆菌、大肠埃希菌等。结论儿科重症监护室内呼吸机相关性肺炎的痰培养以革兰阴性杆菌为主,其耐药率高,革兰阳性菌仍以葡萄球菌属为主,临床医师应选择合理抗生素治疗,必要时联合用药。

Objective To investigate the distribution and the resistance of pathogens from the children with VAP,and to analyze the reasons of antibiotics resistance of the pathogens.Methods The sputum obtained from the children with final diagnosis of VAP in PICU was cultured and identified from Jan 2007 to Dec 2010.The resistance of the bacteria identified to antibiotics used frequently was determined by Kirby-Bauer method.Results Censorship of 120 sputum specimens,training result positive 91.6% in 110 cases,positive.138 strains bacteria were detected from the same patients repeat excluded strains,including gram-negative bacilli,accounting for 99 strains 72.1%,gram-positive cocci 28 strains（20.4%）;Fungi 11 strains（7.9%）.The most common bacteria pneumonia crayresearch,followed by BaoShi motionless bacili,escherichia coli,etc.Conclusion The main strains cultured from the sputum specimens of children with VAP in PICU are Gram-negative bacilli with high resistance rates to antibiotics.Gram-Positive still with staph primarily,clinicians should choose reasonable antibiotics,necessary combination.