重症肺炎患儿继发抗生素相关性腹泻病原菌检测与肠镜观察

The Pathogen and Colonoscopy Detection of Severe Pneumonia Children with Antibiotic-associated Diarrhea

目的:探讨重症肺炎患儿继发抗生素相关性腹泻(Antibiotic-associated diarrhea,AAD)的肠道病原菌及肠镜情况。方法:回顾性分析本院2012年3月-2014年3月本院内科重症监护室283例重症肺炎继发AAD患儿的临床资料,检测肠道病原菌,电镜观察肠道病理变化。结果:283例患儿的粪便检出艰难梭菌(Clostridium difficile,CD)毒素阳性标本48例,283例患儿的粪便培养后检出优势生长的白色假丝酵母菌127例、大肠埃希氏菌114例、金黄色葡萄球菌43例、产气荚膜梭菌35例、产酸克雷伯菌26例、阴沟肠杆菌19例、肺炎克雷伯菌16例、铜绿假单胞菌8例。电镜检查CD相关性AAD(CDAD)26例有黄白色伪膜斑,其他病原菌相关性AAD 67例显示有炎性变化。结论:重症肺炎继发AAD患儿的病原菌种类较复杂,以优势生长的白色假丝酵母菌、大肠埃希氏菌检出率最高。肠镜检测CDAD与其他病原菌相关性AAD显示出不同的炎症变化。

Objective： To investigate the intestinal pathogen and colonoscopy of diarrhea in children with severe pneumonia.Method： 283 children with severe pneumonia in our hospital were analyzed retrospectively the etiological data of antibiotic associated diarrhea from March 2012 to March 2014. Result： The results dictated there were 48 samples toxin- positive of clostridium difficile, and after culturing there were 127 cases of Candida albicans, 114 cases of Escherichia coli, 43 cases of Staphyloccocus aureus, 35 cases of clostridium perfringens, 26 cases of Klebsiella oxytoca, 19 cases of enterobacter cloacae, 16 cases of Kiebsiella pneumoniae and 8 cases of pseudomonas aeruginosa in the fecal specimens of 285 severe pneumonia children with antibiotic associated diarrhea. Colonoscopy detection showed there were 26 cases of pseudomemhranous spots in all CD infection children, 67 cases of inflammatory in other bacterial infections children. Conclusion： Severe pneumonia children with antibiotic associated diarrhea have complicated pathogens, the best pathogens are candida albicans and Escherichia coll. Colonoseopy detection shows different inflammatory changes in these pathogens associated AAD.