细菌性重症肺炎患儿的病原菌分析及治疗对策

目的探讨小儿细菌性重症肺炎的致病菌种类,寻找其治疗对策,为临床抢救细菌性重症肺炎患儿首选抗生素提供参考依据。方法对216例重症肺炎患儿的痰液进行细菌培养,并采用美国MicroScanA S4型细菌鉴定药敏分析仪进行细菌鉴定及药物敏感分析。结果216例重症肺炎患儿痰菌培养阳性者128例,检出率为59.25%,获病原菌161株,其中,革兰阴性杆菌73株(分别为肺炎克雷伯菌42株,大肠埃希菌13株,铜绿假单孢菌11株,阴沟肠杆菌7株),肺炎链球菌40株,金黄色葡萄球菌28株,其他细菌20株。在药物敏感试验中,检出的病原菌对亚胺培南、头孢吡肟、哌拉西林他唑巴坦均有很高的敏感率;对万古霉素、阿米卡星、庆大霉素及喹诺酮类也有较高的敏感率。结论细菌性重症肺炎患儿的病原菌主要为革兰阴性杆菌(尤其以肺炎克雷伯菌多见),其次依次为肺炎链球菌、金黄色葡萄球菌及其他细菌;对亚胺培南、头孢吡肟、哌拉西林他唑巴坦及万古霉素、阿米卡星、庆大霉素、喹诺酮类的敏感率高,但万古霉素、阿米卡星、庆大霉素、喹诺酮类对小儿均有较大的不良反应,故对细菌性重症肺炎患儿的抗菌治疗,应首选亚胺培南、头孢吡肟或哌拉西林他唑巴坦。

The pathogenic analysis and therapy of children with severe bacteria pneumonia

Objective To investigate the pathogenic varieties of severe bacteria pneumonia,find out the the rapy and provide thereference for choosing antibiotics for the salvage of children with severe bacteria pneumonia.Methods The sputum sampled from 216 cases from January 2000 to October 2003 in PICU was cultured.America-manufactured A/S mode 4 for bacteria identify and medicine sensitivity analyzer was utilized for evaluation and analysis of drug sensitivity.Results The sputum of 128 cases was detected positive,which were identied in 59.25%.161 pathogenic trunks were obtained.There were 73 trunks of Gram-Negative bacillus (Klebsiella pneumonia 42 trunks,Escherichia coli 13 trunks,Pseudomonas aeruginosa 11 trunks,Enterobacter cloacae 7 trunks,respectively);40 of streptococcus pneumoniae;28 ofstaphylococcus aureus,20 of other bacteria.Sensitivity tests showed a high sensitivity of pathogen to Imipenem,Cefepime,Piperacillin/Tazobactam ,Vancomycin,Amikacin,Gentamycin and quinolones.Conclusion The pathogens of severe bacteria pneumonia are primarily Gram-Negative bacillus (Klebsiella pneumonia is in chief) ,the next by turns are streptococcus pneumoniae,staphylococcus aureus and other bacteria.Antibiotics have a higher sensitivity to Imipenem,Cefepime,Piperacillin/Tazobactam,Vancomycin,Amikacin,Gentamycin and quinolones.But antibiotics such as Vancomycin,Amikacin,Gentamycin and quinolones have higher adverse effects to patients.So,for the rescue therapy to children with severe bacteria pneumonia,Imipenem,Cefepime and Piperacillin/Tazobactam are the priorities.