128例小儿重症肺炎病原学分析

Etiology analysis of severe pneumonias in 128 children

目的探讨小儿重症肺炎的病原学构成,为小儿重症肺炎的防治提供依据。方法以我院近5年来重症肺炎患儿128例为研究对象,对其进行细菌培养及药物敏感性分析、肺炎支原体、呼吸道合胞病毒、腺病毒、流感病毒等检测,对检测结果进行回顾性分析。结果 128例患儿病原检出率为67.2%(86/128),细菌培养阳性率40.7%(52/128),病原菌82株,其中革兰阴性杆菌52株(63.4%),以肺炎克雷伯菌、铜绿假单胞菌为主;革兰阳性球菌30株(36.6%)以金黄色葡萄球菌、肺炎链球茵为主。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-西司他丁有较高的敏感率,革兰阳性球菌对万古霉素敏感率达90%以上。病毒检测阳性24例(18.7%),其中腺病毒10例,呼吸道合胞病毒6例,流感病毒4例。另肺炎支原体阳性10例(7.8%)。结论小儿重症肺炎的病原体种类繁多,涉及细菌、病毒及肺炎支原体,掌握重症肺炎患儿病原体对其防治有重要意义。

Objective To explore the etiology construction of severe pneumonias in children and to provide references for its prevention and treatment.Methods Totally 128 children with severe pneumonias in our hospital in recent five years were enrolled.Bacterial culture,drug sensitivity analysis,detection of mycoplasma pneumonia,respiratory syncytial virus,adenovirus and influenza virus were conducted and the results were analyzed retrospectively.Results The etiological detection rate was 67.2%（86/128） and the bacterial culture positive rate was 40.7%（52/128）.Eighty-two stains of pathogenic bacteria were detected including 52 strains of gram negative bacilli（63.4%） and 30 strains of gram positive coccus（36.6%）.The gram negative bacilli were mainly Klebsiella pneumonia and Pseudomonas aeruginosa while the gram positive coccus were mainly Staphylococcus aureus and Streptococcus pneumonia.The results of drug sensitivity showed that most of pathogenic bacteria were resistant to Penicillins and Cephalosporins but sensitive to Imipenem-Cilastatin.The sensitive rate of the gram positive cocci to Vancomycin was more than 90%.There were 24 children（18.7%） had a positive infection of virus including 10 cases with adenovirus,6 cases with respiratory syncytial virus,4 cases with influenza virus and 10 cases（7.8%） with positive mycoplasma pneumonia.Conclusion The pathogen of severe pneumonias in children is various including bacterium,virus and mycoplasma pneumonia.Understanding the etiology of severe pneumonias in children is helpful for its prevention and treatment.