小儿呼吸机相关性肺炎病原菌分布及耐药性分析

Analysis of distribution and drug resistance ofpathogenic bacteria in children with ventilatorassociatedpneumonia

目的分析小儿呼吸机相关性肺炎(VAP)病原菌分布情况及耐药性。方法回顾性分析2018年1月至2020年10月日照市中医医院收治的56例VAP患儿的临床资料,采集所有患儿气道分泌物进行病原菌培养及药敏试验,分析病原菌分布情况及耐药性。结果56例VAP患儿以晚发型为主,占比69.64%;共检出61株病原菌,其中革兰阴性菌47株(77.05%),以鲍曼不动杆菌(29.51%)、铜绿假单胞菌(22.95%)、肺炎克雷伯菌(14.75%)为主;革兰阳性菌12株(19.67%),以金黄色葡萄球菌(8.20%)、肺炎链球菌(6.56%)为主;真菌2株(3.28%)。主要革兰阴性菌鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对头孢噻肟、头孢曲松、头孢唑林耐药性均>50.00%,对亚胺培南、美罗培南未产生耐药性。革兰阳性菌金黄色葡萄球菌、肺炎链球菌对青霉素、氨苄西林、红霉素耐药性均≥75.00%,对替考拉宁、万古霉素未产生耐药性。结论小儿VAP以晚发型为主,革兰阴性菌为主要致病菌,且整体致病菌对常规抗菌药物呈广谱耐药现象,需依据药敏结果选用针对性药物治疗,促进感染消退。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in children with ventilator-associated pneumonia(VAP).Methods Clinical data of 56 children with VAP admitted to Rizhao Traditional Chinese Medicine Hospital from January 2018 to October 2020 were retrospectively analyzed,airway secretions of all children were collected for examination,pathogen culture and drug sensitivity tests,and the distribution and drug resistance of pathogens were analyzed.Results Among the 56 VAP children,there were mainly late-onset VAP,accounting for 69.64%.A total of 61 strains of pathogens were detected,there were 47 Gram-negative bacteria(77.05%),mainly Acinetobacter baumannii(29.51%),Pseudomonas aeruginosa(22.95%)and Klebsiella pneumoniae(14.75%);there were 12 strains of Gram-positive bacteria(19.67%),and mainly Staphylococcus aureus(8.20%)and Streptococcus pneumoniae(6.56%);2 strains of fungi(3.28%).The main Gram-negative bacteria,the re-sistance of Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae to cefotaxime,ceftriaxone,cefzorim were>50.00%,but did not develop resistance to imipenem and meropenem.The main Gram-positive bacteria,the resistance of Staphylococcus aureus and Streptococcus pneumoniae to penicillin,ampicillin and erythromycin were≥75.00%,but did not develop resistance to teicoplanin and vancomycin.Conclusion Pe-diatric VAP is mainly late-onset,with Gram-negative bacteria as the main pathogenic bacteria,and the overall pathogenic bacteria are broad-spectrum resistant to conventional antibacterial drugs,it is necessary to select targeted drug treatment according to the drug sensitivity results to promote the resolution of infection.