PICU危重患儿呼吸道感染调查分析

Investigation of respiratory tract infections in PICU critically ill children

目的探讨住院危重患儿呼吸道感染状况,为其治疗提供参考依据。方法调查2011年1月-2014年12月儿科重症监护病房(PICU)进行治疗的危重患儿1000例,根据患儿的年龄将其分为≤6月龄组538例与>6月龄组462例,对比两组患儿呼吸道感染率,病原菌鉴定与药敏试验采用VITEK-AMS32全自动细菌鉴定与药敏分析仪及配套鉴定卡、药敏卡进行鉴定,分析呼吸道感染患儿的病原菌分布及耐药性,采用SPSS17.0软件进行统计分析。结果 1000例危重患儿发生呼吸道感染38例,感染率为3.8%;>6月龄组患儿呼吸道感染率为2.2%,显著低于≤6月龄组患儿感染率,差异有统计学意义(P<0.05);呼吸道感染患儿共分离出45株病原菌,革兰阴性菌25株占55.6%,革兰阳性菌11株占24.4%,真菌9株占20.0%;病原菌主要以肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、白色假丝酵母菌为主,分别占20.0%、13.3%、17.8%和15.6%;革兰阴性菌对常用抗菌药物亚胺培南、环丙沙星、阿米卡星、庆大霉素、左氧氟沙星均较敏感,金黄色葡萄球菌对利奈唑胺、万古霉素较为敏感,白色假丝酵母菌对两性霉素B、咪康唑、酮康唑、伊曲康唑、制霉菌素均敏感。结论≤6月龄危重患儿呼吸道感染发生率较高,感染病原菌以革兰阴性菌为主。

OBJECTIVE To explore the respiratory tract infections in PICU children patients and to provide evidence for the treatment of respiratory tract infections in children.METHODSA total of 1000 cases of critically ill children treated in PICU from Jan.2011 to Dec.2014 in our hospital.According to children ages,they were divided into two groups：≤6-month old group（n=538）and 〉6-month old group（n=462）.The incidence of respiratory tract infections in the two groups were compared,and the distribution and drug resistance of pathogenic bacteria in children with respiratory tract infection were analyzed using VITEK-AMS32 automatic bacterial identification,susceptibility analyzers,matching identification card and Minka drug identification.Respiratory infections in children and antibiotic resistance were analyzed.The results were statistically analyzed by software SPSS 17.0.RESULTSThere were 38 cases of respiratory tract infections in the 1000 cases of critically ill children with an infection rate of 3.8%.The respiratory tract infection rate of patients in 〉6-month old group was 2.2% which was significantly lower than that of≤6-month old group with an infection rate of 5.2%.The difference has statistical significance（P〈0.05）.A total of 45 strains of pathogenic bacteria were isolated from the infected children：25strains of gram-negative bacteria accounting for 55.6%,11 strains of gram-positive bacteria accounting for 24.4%and 9strains of fungi and accounting for 20.0%.Pathogenic bacteria mainly contained Klebsiellapneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus and Candida albicans respectively accounting for 20.0%,13.3%,17.8% and 15.6%.Gram-negative bacteria were more sensitive to commonly used antimicrobial drugs such as imipenem,ciprofloxacin,amikacin,kanamycin,gentamycin and levofloxacin.Staphylococcus aureus were more sensitive to linezolid and vancomycin.C.albicans were sensitive to amphotericin B, MI miconazole,ketoconazole,itraconazole and nystatin.CONCLUSION The respiratory tract infections rate in critically ill children patients in ≤6-month old group is higher,and the main pathogen is gram negative bacteria