重症肺炎患儿非发酵菌感染的临床分析

Clinical analysis of non-fermenting bacteria infections in severe pneumonia children

目的了解医院碳青霉烯类使用后发生重症肺炎患儿非发酵菌感染的临床特点,减少多药耐药菌产生,为临床合理应用广谱抗菌药物提供依据。方法以2009年10月-2012年10月的202例重症肺炎患儿作为研究对象,对其下呼吸道分泌物培养出的非发酵菌进行分析,采用常规方法培养及鉴定细菌,K-B法检测病原菌的药敏率。结果 202例重症肺炎患儿非发酵菌检出75株,检出率为37.13%,每年呈递增趋势,其中碳青霉烯类使用后非发酵菌的检出率为12.38%,占33.33%,每年亦呈递增趋势;非发酵菌中铜绿假单胞菌、嗜麦芽寡养单胞菌、鲍氏不动杆菌、产碱假单胞菌分别占38.67%、24.00%、17.33%、10.67%,占前3位的3种细菌每年的检出率均呈递增趋势;检测出非发酵菌的重症肺炎患儿科室分布PICU 28例占37.33%,NICU 22例占29.33%;3种主要的非发酵菌对头孢哌酮/舒巴坦、左氧氟沙星的耐药率逐年均无明显变化,对亚胺培南/西司他丁耐药率均在逐年增加;碳青霉烯类使用后,年龄<3月龄、早产、先天性心脏病、营养不良是重症肺炎患儿非发酵菌感染的高危因素。结论重视重症肺炎患儿碳青霉烯类使用后发生感染的高危因素,及时进行下呼吸道分泌物的培养,减少耐药菌的产生,做到更合理应用广谱抗菌药物。

OBJECTIVE To understand the clinical characteristics of non-fermenting bacteria infections in the children with severe pneumonia after being exposed to carbapenems and reduce the multidrug-resistant bacteria so as to provide basis for the reasonable use of broad spectrum antibiotics. METHODS A total of 202 children with severe pneumonia admitted in the hospital from Oct 2009 to Oct 2012 were studied, the non-fermentating bacteria in the respiratory secretions were analyzed, conventional method was used to cultivate and identify bacteria, K-B assay was carried out to detect the drug susceptibility of the pathogens. RESULTS The bacterial detection rate of the non-fermenting bacteria among the 202 cases of severe pneumonia children was 37.13% （75/202） ; the detec- tion rate showed an increasing trend each year; while the detection rate of the non-fermentating bacteria in the chil- dren exposed to carbapenems was 12.38% （25/202）, accounting for 33.33%, the detection rate also displayed an increasing trend each year. Among the 75 children infected with non-fermenting bacteria, Pseudomonas aeruginosa accounted for 38.67%, Stenotrophomonasmaltophilia 24.00%, Acinetobacterbaumannii 17.33%, Pseudomonas alcaligenes 10.67% ; the detection rates of the top three species of bacteria showed upward trend. Of the severe pneumonia children detected positive for the non-fermenting bacteria, 37.33%（28 cases） distributed in PICU, 29.33% （22 eases） in NICU. The drug resistance rates of the three major species of non-fermenting bacteria to eefoperazone-sulhactam and levofloxacin did not change significantly, the drug resistance rate to imipenem-cilasta- tin was increased year by year. The exposure to carbapenems, less than three months of age, prematurity, congenital heart disease, and malnutrition were the high risk factors of the non-fermenting bacteria infections in the children with severe pneumonia. CONCLUSION It is important to focus on such high risk factors as the expo- sure to the earbapenems, cultivate the lower respiratory tract secretions in a timely manner, reduce the drugresistant bacteria, and reasonably use broad spectrum antibiotics.