儿童呼吸机相关性肺炎的病原学分析

A PATHOGENIC ANALYSIS OF VENTILATOR-ASSOCIATED 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情况。方法总结2010年3月—2013年12月机械通气治疗113例患儿的临床资料,比较机械通气时间及重复插管等因素与VAP发生率的关系,对49例诊断为VAP患儿病原学资料进行回顾性分析。结果 113例进行机械通气的患儿有49例发生了VAP,发生率43.36%,通过统计分析发现VAP的发生于插管次数、机械通气时间密切相关;49例VAP患儿检出病原菌57株,多为耐药菌,其中革兰阴性菌48株(84.21%),主要为肺炎克雷伯菌(12株),铜绿假单胞菌(11例);革兰阳性菌9株(15.79%),主要为金黄色葡萄球菌(7株),其中耐甲氧西林株5株(8.77%)。结论 VAP的病原以革兰阴性菌为主,细菌普遍耐药。

Objective To explore the pathogenic distribution and drug resistance of ventilator- associated pneumonia（VAP） in children. Methods The clinical data of 113 patients were summarized in the treatment with mechanical ventilation between march, 2010 and December, 2013. The relationship between the me- chanical ventilation time, repeated intubation and other factors and the incidence of VAPo were analyzed. Retrospectively analysis was used to analysis the etiological data of 49 patients with VAP. Results Of the 113 patients with mechanical ventilation, 49 cases had been diagnosed with VAP, accouting for 43.36%. According to statistical analysis, we found that the incidence of VAP had relationship with the time of me chanical ventilation and intubation times. Of all the 49 cases of VAP, we detected 57 strains of pathogenic bacteria, most of which were multi resistant bacteria, including gram negative bacilli 48 isolates （84. 21%） which mainly for pneumonia gram Klebsiella pneumoniae （12 strains）, Pseudomonas aeruginosa （11 ca- ses）, gram positive bacilli 9 isolates （15.79%） which mainly for Staphylococcus aureus （7 strains）, inclu- ding methicillin- resistant strains 5 strains （8.77%）. Canelusion The pathogeny of VAP is mainly gram negative bacteria, and the bacteria has generally drug- resistance.