儿童呼吸机相关性肺炎病原菌分布及耐药性分析

Pathogenic bacteria analysis of ventilator associated pneumonia in children

目的对儿童呼吸机相关性肺炎（ventilator associated pneumonia, VAP）的主要病原菌的分布及耐药性进行观察分析，以指导临床的规范化治疗。方法回顾性分析2014年1月-2016年12月哈尔滨医科大学附属第一医院PICU44例VAP患者的痰培养及药敏结果。结果44例VAP患者的样本检测分离出病原菌49株，其中有5例患儿前后分离出两种菌株。49株病原菌中革兰阴性菌44株，占89．8％，依次为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、洋葱博克霍尔德菌和嗜麦芽窄食单胞菌等，以非发酵菌为主；革兰阳性菌5株占10．2％，主要为葡萄球菌。引起VAP的革兰阴性菌对常用青霉素和头孢菌素类耐药性明显增高，其中鲍曼不动杆菌和肺炎克雷伯菌对碳青霉烯类抗生素耐药性也明显增高。革兰氏阳性菌对阿莫西林、红霉素完全耐药，对厄他培南和万古霉素出现中介，对利柰唑胺敏感性好。结论儿童呼吸机相关性肺炎的主要病原菌是革兰阴性菌，以非发酵菌为主，各种病原菌对常用青霉素、头孢菌素类甚至碳青霉烯类抗生素的耐药性均明显增高，导致治疗困难。临床治疗VAP除根据药敏结果合理应用抗生素外，更主要的应做好防控工作，尽量减少VAP诱因，从而避免VAP发生。

Objective To investigate the distribution of bacteria and observe the antibiotic resistance detected from ventilator associated pneumonia in children. Method The retrospective analysis was performed in the sputum cultures and antibiotics sensitivity results of 44 cases of VAP registered from January 2014 to December 2016 in PICU of the first affiliated clinical hospital of Hrbin medical universitiy. Results The 49 strains of bacteria were isolated from 44 VAP cases,5 of them got two different strains isolated. In the 49 strains, gram-negative bacteria was 44 strains, accounting for 89.8%, followed by acinetobacter baumannii, klebsiella pneumoniae, pseudomonas aeruginosa, burkholderia cepacia and stenotrophomonas maltophilia. Main bacteria was bacteria fermentation.Gram-positive bacterium （5 strains）account for 10.2%, main bacterium was Staphylococcus aureus. The drug resistance to penicillin and cephalosporin of gram-negative bacteria that caused VAP increased obviously, so as to penicillium carbon alkene antibiotics of acinetobacter baumannii and pneumonia klebsiella bacteria.Gram positive bacteria was totally resistant to amoxicillin, mediation to ertapenem and vancomycin, but was sensitive to the Nai linezolid. Conclusion The main pathogenic bacteria of children VAP was gram-negative bacteria, mostly was bacteria fermentation. All kinds of pathogens to penicillin and cephalosporin even penicillium carbon alkene antibiotic resistance were significantly increased, which caused the difficulty in treatment. In addition to use of antibiotics according to the results of the drug susceptibility reasonablely .For clinical prevention and treatment of VAP, more and more work should be done to minimize the VAP incentives in the prevention and control.