重症肺炎患儿病原菌与死亡影响因素分析

Pathogens and influencing factors for death of children with severe pneumonia

目的探究重症肺炎患儿病原菌特点与死亡影响因素。方法回顾性分析2015年1月-2017年1月于医院住院治疗的重症肺炎患儿518例的临床资料,根据预后情况分为死亡组120例和存活组398例;分析患儿标本病原菌特点和耐药性,对两组患儿的并发症情况及相关实验室检查进行比较,归纳影响重症肺炎患儿死亡的影响因素。结果 518例在医院住院治疗的重症肺炎患儿,373例检出病原菌,检出率为72.01%(373/518);检出病原菌421株,其中革兰阴性菌251株占59.62%,革兰阳性菌153株占36.34%,真菌17株占4.04%;主要革兰阴性菌对临床常用抗菌药物均存在一定的耐药性,其中对阿莫西林的耐药率较高,对氨苄西林/舒巴坦较敏感;肺炎链球菌对青霉素、红霉素和克林霉素耐药率较高,金黄色葡萄球菌对青霉素和克林霉素耐药率较高,凝固酶阴性葡萄球菌对红霉素耐药率较高;均对利奈唑胺和磺胺甲噁唑/甲氧苄啶较敏感,均对万古霉素敏感;年龄、合并败血症、脱水、合并低氧血症及胸腔积液是重症肺炎患儿死亡的影响因素(P<0.05)。结论重症肺炎患儿治疗要依据病原菌,选择合理的抗菌药物,同时重症肺炎患儿往往并发症相对较多及实验室相关检查指标发生明显改变,因此必须密切关注患儿病情变化。

OBJECTIVE To investigate the characteristics of pathogens in children with severe pneumonia and to analyze the risk factors affecting their prognosis.METHODS A total of 518 children with severe pneumonia who were hospitalized in the hospital from Jan.2015 to Jan.2017 were enrolled,and divided into death group and survival group according to prognosis.Specimens were collected to analyze the distribution characteristics and drug sensitivity of the pathogens.The complications in the two groups of children and results of related laboratory tests were statistically compared,and the factors affecting the prognosis of children with severe pneumonia were summarized.RESULTS For the 518 cases of severe pneumonia hospitalized in hospital,the detection rate was 72.01%(373/518).421 strains of pathogens were detected,of which 251 strains of gram-negative bacteria accounted for59.62%,153 strains of gram-positive bacteria accounted for 36.34%,and 17 strains of fungi accounted for 4.04%.The main gram-negative bacteria have certain resistance to common clinical antibacterial agents,with relatively high resistance rate to amoxicillin,but they were relatively sensitive to ampicillin/sulbactam.Streptococcus pneumoniae had relatively high resistance rate to penicillin,erythromycin and clindamycin,Staphylococcus aureus had relatively high resistance rate to penicillin and clindamycin,and coagulase-negative Staphylococci had relatively high resistance rate to erythromycin.All these three groups of gram-positive bacteria were relatively sensitive to linezolid and sulfamethoxazole/trimethoprim,and sensitive to vancomycin.Age,complication with septicemia,dehydration,hypoxemia and pleural effusion were independent factors that affected the prognosis of children(P<0.05).CONCLUSIONThe treatment of children with severe pneumonia should be based on the distribution characteristics of pathogens,and antibiotics should be reasonably used.At the same time,children with severe pneumonia often have relatively more complications and significant changes in laboratory-related examination indicators.Therefore,it is necessary to pay close attention to the changes of children’s condition.