左向右分流型先天性心脏病合并下呼吸道感染患儿痰培养病原菌特点及耐药性分析

摘要]目的:分析先天性心脏病合并下呼吸道感染患儿痰培养病原菌分布及耐药性,为临床选用抗菌药物提供依据。方法:选择我院2013年8月至2015年8月住院的先天性心脏病合并下呼吸道感染患儿336例,对其痰液进行培养和药敏试验。结果:分离出病原菌352株,革兰阴性杆菌占79.8%,前3位分别为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌;革兰阳性球菌占15.1%,前3位分别为凝固酶阴性葡萄球菌、金黄色葡萄球菌、肺炎链球菌;真菌占5.1%。药敏结果显示,产超广谱β-内酰胺酶(ESBLs)菌主要为肺炎克雷伯菌和大肠埃希菌。鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率达73.5%,对头孢哌酮/舒巴坦相对敏感(耐药率30.2%)。铜绿假单胞菌对亚胺培南和美罗培南的耐药率为7.7%。革兰阳性球菌中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为47.6%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为 16.7%,未检测出耐万古霉素菌株。肺炎链球菌对青霉素类及头孢菌素类耐药率达60%-100%,对万古霉素、替考拉宁及利奈唑胺高度敏感。结论:先天性心脏病合并下呼吸道感染优势病原菌为革兰阴性杆菌,且混合感染多见,各类细菌对常用抗菌药物表现为多重耐药,应及早并反复多次行深部痰培养检查以提高阳性率,临床上在痰培养未得到结果前可选用以抗革兰阴性杆菌为主的抗菌药物,联用抗革兰阳性球菌的抗菌药物经验治疗方案。

Sputum Culture Pathogenic Characteristics and Drug Resistance in Children with Left to Right Shunt Congenital Heart Disease and Lower Respiratory Tract Infection

Abstract]Objective: To analyze the sputum culture pathogenic distribution and drug resistance in children with left to right shunt congenital heart disease and lower respiratory tract infection, provide reference for antibiotics selection. Methods: A total of 336 children with congenital heart disease and lower respiratory tract infection from August 2013 to August 2015 were selected, and the results of sputum cultures and drug sensitive test were analyzed. Results: Three hundreds and fifty-two strains of bacteria were isolated, and consisting of 79.8% for gram-negative bacilli, ranked the top three were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii. Gram-positive cocci and fungi were counted for 15.1% and 5.1%. Drug sensitivity results showed that the extended spectrum beta lactamases (ESBLs) producing bacteria were mainly Klebsiella pneumoniae and Escherichia coli. The resistance rate of Acinetobacter baumannii to carbapenem dilute antibiotics was 73.5%, and was relatively sensitive to cefoperazone/ sulbactam (resistance rate 30.2%). The resistance rate of Pseudomonas aeruginosa to imipenem and meropenem were 7.7%. The detection rate of methicillin-resistant coagulase negative staphylococci (MRCNS) was 47.6% in gram positive cocci, and the detection rate of methicillin-resistant staphylococcus aureus ( MRSA) was 16.7%. No vancomycin resistant strain was detected. The resistance rates of Streptococcus pneumoniae to penicillin and cephalosporin were 60%-100%, which was highly sensitive to vancomycin, teicoplanin and linezolid.Conclusion: The main pathogens are gram-negative bacilli and mixed infections are universal. The various bacteria are serious resistance to common antimicrobial agents. Appropriate sputum cultures could provide important information to choose reasonable antibiotics and should reduce fungal infection as well as the emergence of drug-resistant bacterial strains.