重症肺炎患儿支气管肺泡灌洗液病原菌分布、药物敏感性及预后危险因素分析

Pathogen distribution,drug resistance of clinical bacteria isolated from bronchoalveolar lavage fluid and prognostic risk factors in children with severe pneumonia

目的:探究支气管肺泡灌洗液病原菌培养、药敏试验结果及预后危险因素分析。方法:选取我院2017年5月〜2020年5月重症肺炎患儿210例,取支气管肺泡灌洗液做病原菌培养及药敏试验,并分析重症肺炎患儿预后影响因素。结果:210例重症肺炎患儿,检出明确病原菌136株,其在革兰阴性菌93株(68.38%),革兰阳性菌38株(27.94%),真菌5株(3.68%);检出率位于前5位的病原菌分别为大肠埃希菌、肺炎克雷伯杆菌、铜绿假单胞菌、肺炎链球菌、金黄色葡萄球菌;主要革兰阴性菌对二、三代头孢菌素耐药性较高,对亚胺培南/西司他丁、哌拉西林/他唑巴坦、左氧氟沙星、环丙沙星、阿米卡星耐药率较低;主要革兰阳性球菌对青霉素G、红霉素、苯唑西林、阿莫西林耐药率较高,对利奈唑胺、万古霉素无耐药;年龄<3岁、并发症、肺部感染范围、机械通气均是重症肺炎患儿不良预后的独立危险因素(P<0.05)。结论:小儿重症肺炎病原菌以革兰阴性菌为主,患儿预后情况与年龄、并发症、肺部感染范围、机械通气有关,了解病原菌分布、耐药性与患儿预后影响因素对临床治疗具有重要指导意义。

Objective:To explore the pathogen culture,drug sensitivity test results and prognostic risk factors of bronchoalveolar lavage fluid(BALF).Methods:210 children with severe pneumonia in our hospital from May 2017 to may 2020 were selected.The bronchoalveolar lavage fluid was taken for pathogen culture and drug sensitivity test,and the prognostic factors of severe pneumonia were analyzed.Results:In 210 children with severe pneumonia,136 strains of pathogens were detected,including 93 strains of gram-negative bacteria(68.38%),38 strains of gram-positive bacteria(27.94%),and 5 strains of fungi(3.68%);The top five pathogens were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Streptococcus pneumoniae and Staphylococcus aureus.The main gram-negative bacteria had high resistant rates against the second and third generation cephalosporins.The drug resistance rate of gram-positive cocci to penicillin G,erythromycin,oxacillin and amoxicillin was high,but no resistance to linezolid and vancomycin;Age of<3 years old,complications,scope of pulmonary infection and mechanical ventilation were independent risk factors of poor prognosis in children with severe pneumonia(P<0.05).Conclusion:Gram negative bacteria are the main pathogens in children with severe pneumonia.The prognosis of children is related to age,complications,scope of pulmonary infection and mechanical ventilation.Understanding the distribution of pathogens,drug resistance and prognostic factors of children has important guiding significance for clinical treatment.