儿童重症肺炎支气管肺泡灌洗液的病原菌及药敏试验分析

Analysis of pathogens and drug sensitivity tests of bronchoalveolar lavage fluid in children with severe pneumonia

目的了解儿童重症肺炎支气管肺泡灌洗液(BALF)的病原菌及药敏试验情况。方法选取该院2021年1月至2023年4月收治的100例重症肺炎患儿作为研究对象,对所有患儿进行支气管镜肺泡灌洗,并分析其BALF病原菌及药敏试验情况。结果100例患儿BALF中共培养出病原菌131株,革兰阴性菌98株(74.81%),革兰阳性球菌33株(25.19%),其中流感嗜血杆菌(25.19%)、肺炎链球菌(21.37%)占比较高,卡他布兰汉菌(15.27%)、肺炎克雷伯菌(11.45%)其次。重症肺炎患儿BALF中前4位病原菌主要以<1岁(97.37%)、1~3岁(96.88%)占比较高,>3~7岁(94.12%)、>7~14岁(92.31%)相对较少。各年龄BALF中流感嗜血杆菌、卡他布兰汉菌、肺炎克雷伯菌分布情况比较,差异均无统计学意义(P>0.05);各年龄BALF中肺炎链球菌分布情况比较,差异有统计学意义(P<0.05)。20株流感嗜血杆菌对四环素、阿莫西林-克拉维酸、头孢噻肟、复方磺胺甲噁唑均较敏感,对氯霉素敏感性其次,对氨苄西林、头孢克洛、头孢呋辛耐药性均较高;15株卡他布兰汉菌对头孢噻肟较敏感,对氨苄西林耐药性最高;8株肺炎克雷伯菌对头孢噻肟较敏感,对氨苄西林、头孢呋辛、氯霉素耐药性均较高,对阿莫西林-克拉维酸、四环素耐药性其次;20株肺炎链球菌对万古霉素、氯霉素均较敏感,对青霉素G、泰利霉素敏感性其次,对复方磺胺甲噁唑耐药性较高,对四环素、头孢噻肟、克林霉素耐药性其次。结论儿童重症肺炎BALF中病原菌以流感嗜血杆菌、肺炎链球菌多见,且0~3岁患儿病原菌占比高于>3~14岁,临床应合理用药以预防耐药菌株产生。

Objective To investigate the pathogens and drug sensitivity of bronchoalveolar lavage fluid(BALF)in children with severe pneumonia.Methods A total of 100 children with severe pneumonia admitted to the hospital from January 2021 to April 2023 were selected as the research objects.Bronchoscopic alveolar lavage was performed on all children,and the pathogen and drug sensitivity test of BALF were analyzed.Results A total of 131 strains of pathogenic bacteria were cultured in BALF of 100 children,including 98 strains of Gram-negative bacteria(74.81%)and 33 strains of Gram-positive cocci(25.19%),of which Haemophilus influenzae(25.19%)and Streptococcus pneumoniae(21.37%)were relatively high.Branhamia catarrhalis(15.27%),Klebsiella pneumoniae(11.45%)followed.The top four pathogens in BALF of children with severe pneumonia were mainly<1 year old(97.37%)and 1-3 years old(96.88%),while>3-7 years old(94.12%)and>7-14 years old(92.31%)were relatively less.There was no significant difference in the distribution of Haemophilus influenzae,Branhamella catarrhalis and Klebsiella pneumoniae in BALF between different ages(P>0.05).There was a significant difference in the distribution of Streptococcus pneumoniae in BALF among different age groups(P<0.05).Twenty Haemophilus influenzae strains were sensitive to tetracycline,amoxicillin-clavulanic acid,cefotaxime and compound sulfamethoxazole,followed by chloramphenicol,and highly resistant to ampicillin,cefaclor and cefuroxime.Fifteen Branhamia catarrhalis strains were more sensitive to cefotaxime,and most resistant to ampicillin.The 8 Klebsiella pneumoniae strains were sensitive to cefotaxime,and highly resistant to ampicillin,cefuroxime and chloramphenicol,followed by amoxicillin-clavulanic acid and tetracycline.The 20 strains of Streptococcus pneumoniae were sensitive to vancomycin and chloramphenicol,followed by penicillin G and telithromycin.The resistance to compound sulfamethoxazole was high,and the resistance to tetracycline,cefotaxime and clindamycin was second.Conclusion Haemophilus influenzae and Streptococcus pneumoniae are the most common pathogens causing severe Haemophilus influenzae and Streptococcus pneumoniae are the most common pathogens in BALF of children with severe pneumonia,and the proportion of pathogens in children aged 0 to 3 years is higher than that in children aged>3 to 14 years.Clinical drug use should be rational to prevent drug resistant strains.