青岛地区儿童重症社区获得性肺炎肺泡灌洗液病原及药敏分析

Analysis of pathogens and drug sensitivity in bronchoalveolar lavage fluid of children with severe community acquired pneumonia in Qingdao area

目的分析2018至2020年青岛市儿童重症社区获得性肺炎肺泡灌洗液病原分布以及药敏情况。方法收集482例我院收治的青岛地区重症社区获得性肺炎患儿临床资料,使用支气管镜取支气管肺泡灌洗液进行细菌和肺炎支原体等病原的检测。结果(1)482例我院收治的重症社区获得性肺炎患儿检出细菌感染139例(27.84%)、肺炎支原体感染119例(24.69%)、病毒感染141例(29.25%)。(2)1~12月龄组中细菌、病毒感染检出率均较高。>5岁组检出率最高为肺炎支原体。(3)支气管镜下灌洗液细菌培养检出阳性菌株139株:革兰阴性杆菌55株(39.57%),革兰阳性球菌84株(60.43%)。细菌感染中,肺炎链球菌为革兰阳性菌中最为常见;流感嗜血杆菌为革兰阴性菌中最为常见。(4)肺炎链球菌、金黄色葡萄球菌对阿莫西林-克拉维酸钾、万古霉素、利奈唑胺具有较高的敏感度,对红霉素耐药率较高(达100%)。(5)流感嗜血杆菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌对美罗培南、头孢哌酮-舒巴坦敏感度均较高,对阿莫西林、氨苄西林、头孢呋辛均具有较高耐药性(>80%)。结论青岛地区重症社区获得性肺炎中1岁以内患儿以病毒、细菌感染为主,5岁以上以肺炎支原体感染为主;细菌以肺炎链球菌、流感嗜血杆菌为主,分别对万古霉素、利奈唑胺及美罗培南、头孢哌酮-舒巴坦敏感性较高,对红霉素及阿莫西林等耐药率较高。

Objective To analyze the distribution and drug sensitivity of pathogens in bronchoalveolar lavage fluid(BALF)of children with severe community acquired pneumonia(CAP)in Qingdao from 2018 to 2020.Methods The clinical data of 482 children with severe CAP in Qingdao admitted to Women and Children′s Hospital of Qingdao University were collected.BALF was collected by bronchoscopy for detection of bacteria and mycoplasma.Results(1)Bacterial infection was detected in 139 cases(27.84%),mycoplasma infection in 119 cases(24.69%),and virus infection in 141 cases(29.25%).(2)The detection rates of bacteria and virus infection in the 1-12 months old group were higher.The detection rate of mycoplasma pneumoniae was the highest in the group over 5 years old.(3)A total of 139 strains were positive in bacterial culture of lavage fluid under bronchoscope:55 strains(39.57%)of gram-negative bacilli and 84 strains(60.43%)of gram-positive cocci.Streptococcus pneumoniae was the most common gram-positive bacteria.Haemophilus influenzae was the most common gram-negative strain.(4)Streptococcus pneumoniae and Staphylococcus aureus were highly sensitive to amoxicillin clavulanate potassium,vancomycin and linezolid.The resistance rate to erythromycin was high(100%).(5)Haemophilus influenzae,Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were highly sensitive to meropenem and cefoperazone sulbactam.They were highly resistant to amoxicillin,ampicillin and cefuroxime(>80%).Conclusion Severe CAP in Qingdao area is mainly caused by virus and bacteria within 1 year old.Mycoplasma pneumoniae infection is the main cause of children over 5 years old.Respiratory syncytial virus,adenovirus and parainfluenza virus are main causes of virus infection.Streptococcus pneumoniae and haemophilus influenzae are the main pathogens,which are more sensitive to vancomycin,linezolid,meropenem and cefoperazone sulbactam,but resistant to erythromycin and amoxicillin.