小儿医院获得性肺炎的病原菌及危险因素分析

目的调查儿童医院院内获得性肺炎（HAP）的病原菌构成，并分析HAP的危险因素。方法采集深部痰，进行革兰氏染色、细菌培养及药敏测定，并对HAP患儿危险因素进行非条件多因素Logistic回归分析。结果56例HAP患儿以革兰氏阴性菌（90．4％）感染居多，前4位分别是铜绿假单胞菌25％（14／56）、肺炎克雷伯菌21．4％（12／56）、大肠埃希氏菌14．3％（8／56）、鲍曼不动杆菌10．7％（6／56）。Logistic回归分析显示，HAP与住院时间大于7d（P〈0．01）、侵入性操作（P〈0．01）、三代头孢菌素应用（P〈0．05）相关。结论小儿HAP病原菌以革兰氏阴性菌多见，住院时间长、侵入性操作、三代头孢菌素应用是小儿HAP的独立危险因素。

Analysis of pathogenic bacteria and risk factors in children of hospital acquired pneumonia

Objective To investigate the pathogenic bacteria and analyze the risk factors in children of hospital-acquired pneumonia（HAP）. Methods Deep sputum were collected, gram dyeing, bacterial culture and sensitivity test were performed. Risk factors were analyzed with multiple Logistic regression analysis for HAP children. Results Gram-negative bacilli （90.4%） was predominate pathogenic bacteria in HAP children. First four bacterial were pseudomonas aeruginosa in 25% , klebsiella pneumoniae in 21.4%, Eseheriehia coli. in 14.3%, and Baumanli in 10.7%. Multiple logistic regression analysis showed that HAP was related with hospital stays than 7 days（ P 〈 0. 01 ） , invasive operation（ P 〈 0. 01 ） , using third generation cephalosporine （ P 〈 0. 05 ）. Conclusion Gram-negative bacilli was the most common pathogenic bacteria in HAP children. Long period in hospital,invasive operation, using third generation cephalosporine were the independent risk factors for HAP children.