急性重症患儿下呼吸道感染病原菌的耐药性分析

Clinical analysis of bacterial resistance in pediatric patients with severe acute lower respiratory tract infections

目的分析急性重症患儿下呼吸道感染病原菌及其耐药性临床特点,为临床诊疗提供依据。方法选取2012年1月-2015年1月ICU接受治疗的急性重症患儿发生呼吸道感染94例,采用无菌吸痰管在气管插管或者气管切开内吸取痰液,所有标本均采用镜检的方式进行筛选;对采集标本进行革兰染色,然后送至实验室进行痰标本培养,对分离出的病原菌采用微生物鉴定系统(珠海Bact-IST)进行菌株鉴定,确定种属。结果 94例患儿共培养出病原菌117株,其中革兰阳性菌27株占23.48%,革兰阴性菌72株占60.87%;最主要病原菌为铜绿假单胞菌、金黄色葡萄球菌和鲍氏不动杆菌,分别占17.39%,15.65%和14.78%;革兰阴性菌大多为耐药菌与多药耐药菌,对亚胺培南和哌拉西林耐药率相对较低,革兰阳性菌对万古霉素耐药率为0。结论急性重症患儿下呼吸道感染以革兰阴性菌为主,应根据药敏试验选择合适药物。

OBJECTIVE To analyze pathogens in children with severe acute lower respiratory tract infections and clinical characteristics of drug resistance,so as to provide the basis for clinical diagnosis and treatment.METHODS Totally 94 children with severe acute respiratory infections treated in ICU during Jan.2012-Jan.2015 were selected.Sputum specimens were collected by tracheal incubation of the sterile suction tube or tracheotomy to draw sputum.All specimens were screened by microscopy.The collected specimens were treated by gram staining and were sent to the laboratory for culture.The isolated microbial pathogens were identified by the identification system（Zhuhai Bact-IST）to determine the species.RESULTS Totally 117 pathogens were cultured from the 94 children,including 27gram-positive bacteria accounting for 23.48% and 72gram-negative bacteria accounting for60.87%.The main bacterial pathogens were Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter baumannii,accounting for 17.39%,15.65% and 14.78%,respectively.Gram-negative bacteria were mostly resistant and multidrug resistant bacteria,with low sensitivity to imipenem and piperacillin.Gram-positive bacteria had a zero resistance to vancomycin.CONCLUSIONSevere acute lower respiratory tract infections in children is mainly caused by gram-negative bacteria.Antibiotic agents should be selected based on susceptibility testing.