2097例毛细支气管炎患儿痰细菌培养与临床分析

SPUTUM BACTERIA CULTURE AND CLINICAL ANALYSIS IN 2097 INFANTS WITH BRONCHIOLITIS

目的研究儿童毛细支气管炎痰培养主要病原菌、耐药情况及相关的临床因素。方法回顾性分析2007年9月至2010年9月在临沂市人民医院儿科呼吸病房因毛支炎住院患儿的痰细菌培养和药敏分析,共2097例,比较痰培养阳性组和阴性组在某些临床因素上的差异。结果以痰培养结果将患儿分为痰培养阳性组及阴性组,痰培养阳性组470例,阳性率为22.41%,培养出17种481株细菌。以革兰氏阴性菌为主,前五位依次是肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌、醋酸钙鲍曼复合不动杆菌,对美罗培南、亚胺培南高度敏感。革兰氏阳性菌中主要为肺炎链球菌和金黄色葡萄球菌,对万古霉素、利奈唑胺高度敏感。两组在发病年龄、入院时白细胞总数、中性粒细胞比例、住院天数方面差异有统计学意义(P<0.05)。年龄越小,痰培养阳性率越高。结论毛支炎患儿合并细菌感染者,病原菌以革兰氏阴性菌为主,且易出现耐药性;患儿年龄越小,越容易合并细菌感染。

Objective To investigate the major sputum pathogenic bacteria, drug resistance and relevant clinical factors in bronchiolitis. Methods Sputum bacterial identification and drug resistance of 2097 infants with bronchiolitis were retrospectively analyzed, and some differences in clinical factors between the bacteria-positive and the negative group were compared. Results Sputum from 470 children was positive, with the positive rate being 22.41%. 17 pathogenic bacteria and 481 strains were isolated from the sputum samples. The chief pathogens were Gram-negative bacilli, and the 5 most commonly isolated Gram-negative bacteria were Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginosa and Acinetobacter Calcoaceticus-baumannii, which were highly sensitive to meropenem and imipenem. The chief Gram-positive bacteria were Streptococcus pneumoniae and Staphylococcu aureus, and they were highly sensitive to vancomycin and linezolid. Compared with the sputum bacteria-negative group, the sputum bacteria-positive group were younger age and had longer length of hospital stay. The earlier the onset was, the higher the sputum bacteria positive rate was. Conclusion Complicated bacteria infection in bronciolitis deserves attention, especially in little infants. The rational application of antibiotics should be ensured to prevent the drug resistance of pathogens.