儿童呼吸机相关性肺炎病原菌分布及耐药性调查

Distribution and drug resistance of pathogens causing ventilatorassociated pneumonia in children

目的探讨儿童呼吸机相关性肺炎(VAP)的病原菌分布及耐药性,为临床诊治儿童呼吸机相关性肺炎提供参考依据。方法采用前瞻性研究,调查2012年1-12月ICU患儿发生VAP临床资料,对确诊发生VAP患儿病原菌及耐药性进行统计分析。结果 2012年全年收入ICU行机械通气且插管时间>48h患儿共729例,发生呼吸机相关性肺炎45例,发生率为6.17%;VAP患儿中共分离出56株病原菌,以革兰阴性菌为主,共50株占89.3%,主要的病原菌为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌;革兰阳性菌6株占10.7%,主要病原菌为金黄色葡萄球菌、粪肠球菌D群;从56株病原菌中检出多药耐药菌株10株占17.9%;铜绿假单胞菌对美罗培南和亚胺培南耐药率分别为22.2%和33.3%,鲍氏不动杆菌对亚胺培南的耐药率为12.5%,肺炎克雷伯菌对碳青霉烯类药物未产生耐药性。结论儿童呼吸机相关性肺炎病原菌仍以革兰阴性菌为主,临床医师必须按照药敏结果合理使用抗菌药物,制定有效的VAP防治措施,降低VAP发病率。

OBJECTIVE To explore the distribution and antimicrobial resistance of the pathogens causing ventilatorassociated pneumonia （VAP） in children so as to provide guidance for clinical diagnosis and treatment of VAP. METHODS The clinical data of the children with VAP who were treated in the ICU from Jan to Dee 2012 were investigated by means of prospective survey, then the distribution and drug resistance of the pathogens isolated from the children with conformed VAP were statistically analyzed. RESULTS Of totally 729 children who underwent the mechanical ventilation and intubation in the ICU more than 48 hours in 2012, the VAP occurred in 45 cases with the incidence of 6.17%. A total of 56 strains of pathogens have been isolated from the children with VAP, including 50 （89.3%） strains of gram-negative bacteria and 6 （10.7%） strains of gram-positive bacteria; the Pseudomonas aeruginsa, Klebsiella pneumoniae, and Acinetobacter baumannii were dominant among the gram-negative bacteria~ the Staphylococcus aureus and Enterococcus faecalis D group were the predominant gram-positive bacteria. Totally 10 strains of multidrug-resistant bacteria have been detected from the 56 strains of pathogens, accounting for 17.9%. The drug resistance rate of the P. aeruginosa to meropenem was 22.2%, imipenem 33.3%3 the drug resistance rate of the A. baumannii to imipenem was 12.5% ; the K. pneumonia was not resistant to carbapenems. CONCLUSION The gram-negative bacteria are the main pathogens causing VAP in the children; it is necessary for the clinician to reasonably use antibiotics in accordance with the result of drug susceptibility testing and formulate effective prevention measures so as to reduce the incidence of VAP.