儿科重症监护病房机械通气相关肺部感染的病原菌调查及耐药性分析

Surveillance of pathogens distribution and bacterial resistance of ventilator associated pneumonia in a pediatric intensive care unit

目的调查儿科重症监护病房机械通气相关肺部感染的病原菌并分析其耐药性,以指导临床合理用药。方法对2011年1月～2012年12月本院PICU收治的机械通气(MV)时间≥48hr的288例患儿行下呼吸道分泌物标本病原菌分离,并对致病菌进行鉴定,同时行药物敏感性试验。结果 288例MV时间≥48hr的患儿中75例发生VAP,VAP发病率为26.0%。75例发生VAP的患儿中,共送检下呼吸道分泌物标本166份,分离出病原菌105株,培养阳性率为63.3%。其中革兰阳性菌(G+菌)占19.0%(20株),革兰阴性菌(G-菌)占73.3%(77株),真菌占7.6%(8株)。VAP致病菌分布列前5位的依次是鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和大肠埃希菌,以G-菌占明显优势。药敏结果显示培养所得致病菌存在一定耐药性。最终19例因VAP死亡,病死率25.3%。结论 PICU住院患儿行MV易导致VAP,主要病原菌为G-菌,耐药性较高,应引起重视。合理选用抗感染药物对VAP患儿的治疗具有重要意义。

Objective To investigate pathogens distribution and bacterial resistance of ventilator associated pneumonia in a pediatric intensive care unit,thus to guide clinical rational administration. Methods Lower respiratory tract pathogen samples were collected and detected from 288 children who received mechanical ventilation（MV）over 48 hr in PICU from January 2011 to December 2012. Identification and susceptibility testing were done. Results 75 children developed VAP,incidence was 26.0%.105 bacterial strains were isolated from 166 lower respiratory tract pathogen samples of 75 cases with VAP,positive ratio was 63.3%.Among 105 bacterial strains,Gram-positive bacteria（G＋ bacteria） accounted for 19.0%（n=20）,Gram-negative bacteria（G-bacteria）accounted for 73.3%（n=77）and fungus accounted for 7.6%（n=8）.The predominant pathogens were A.baumannii,K.pneumoniae,P. aeruginosa, S. aureus and E. coli,G-bacteria were in dominant position.Susceptibility results show serious bacterial resistance. 19 children died reason to VAP,fatality ratio was 25.3%. Conclusion Children hospitalized in PICU supported with MV are easy to develop VAP,main pathogens were G-bacteria. As regard to serious bacterial resistance we must pay attention to the outcome of bacterial culture and bacterial resistance analysis on the reasonable selection of antimicrobial therapy.