372例先天性心脏病合并社区获得性肺部感染患儿痰培养及药敏试验结果分析

Sputum Culture and Drug Sensitivity in 372 Children with Congenital Heart Disease Complicated with Community Acquired Pulmonary Infection

目的:了解我院先天性心脏病合并肺部感染患儿痰培养及药敏试验结果,为临床早期合理用药提供参考。方法:回顾性分析我院儿科2014年1月至2018年8月收治住院的先天性心脏病合并肺部感染患儿共372例,年龄(1.5±0.5)岁,均于入院时经无菌吸痰管吸取气管深部痰液,送检验科行痰培养及药敏试验,对痰培养及药敏试验结果进行统计分析。结果:痰培养病原菌阳性率48.7%(181/372),检出病原菌27种,包括G;菌16种、G;菌6种、真菌5种。G;菌以大肠埃希菌、肺炎克雷伯菌为主,G;菌以金黄色葡萄球菌、肺炎链球菌为主;药敏试验提示,主要病原菌对碳青霉烯类、第三代头孢菌素、氟喹诺酮类敏感性较高,对青霉素类、第一代头孢菌素及第二代头孢菌素敏感性较低;金黄色葡萄球菌对万古霉素、利奈唑胺、第三代头孢菌素、喹诺酮类敏感,对青霉素的耐药率较高。结论:先天性心脏病合并肺部感染患儿痰培养以G;菌为主,细菌对第三代头孢菌素敏感性较高。临床医师在药敏试验结果未明之前,可经验性首选第三代头孢菌素,其次可酌情选用碳青霉烯类,必要时可选用喹诺酮类;若临床疑似或痰培养结果为金黄色葡萄球菌感染,可首选利奈唑胺。

Objective:To investigate the results of sputum culture and drug sensitivity test in children with congenital heart disease complicated with pulmonary infection in our hospital,so as to provide reference for early rational drug use in children.Methods:A total of 372 children with congenital heart disease complicated with pulmonary infection,aged(1.5±0.5)years,admitted into our hospital from Jan.2014 to Aug.2018 were retrospectively analyzed.The deep tracheal sputum was absorbed through the sterile sputum suction tube on admission and sent to the clinical laboratory for sputum culture and drug sensitivity test.The results of sputum culture and drug sensitivity test were statistically analyzed.Results:The positive rate of pathogenic bacteria in sputum culture was 48.7%(181/372),and 27 kinds of pathogenic bacteria were detected,including 16 kinds of G;bacteria,6 kinds of G;bacteria and 5 kinds of fungi.Escherichia coli and Klebsiella pneumoniae were the most common strains of G;bacteria,while Staphylococcus aureus and Streptococcus pneumoniae were the most common strains of G;bacteria.Drug sensitivity test indicated that the main pathogens were more sensitive to carbapenems,the third generation cephalosporins and fluoroquinolones,but less sensitive to penicillins,the first generation cephalosporins and the second generation cephalosporins.S.aureus was sensitive to vancomycin,linezolid,the third generation cephalosporins and quinolones,and had a high drug resistance rate to penicillin.Conclusion:The sputum culture of children with congenital heart disease complicated with pulmonary infection is dominated by G;bacteria,and the bacteria are highly sensitive to the third generation cephalosporins.The third generation cephalosporins can be empirically preferred before the results of the drug sensitivity test are clear,followed by carbapenems as appropriate,and quinolones if necessary;if the sputum culture results are S.aureus infection,linezolid can be preferred.