婴儿重症肺炎并心力衰竭148例病原学分析

目的了解青岛市儿童医院重症监护病房（ICU）重症肺炎的病原学分布及其对药物的敏感性。方法2005年3月～2007年3月,我院ICU收治符合1987年小儿肺炎防治方案诊断标准的重症肺炎并心力衰竭婴儿共148例,对其痰液做细菌学检测,咽拭子标本行肺炎支原体PCR检测,试验方法严格按照美国国家临床实验室标准委员会（NCCLS）最新标准进行。结果革兰阴性细菌是本组婴儿重症肺炎并心力衰竭的主要致病菌,其中大肠埃希菌最常见（25.49%）,肺炎链球菌次之（17.64%）,之后依次是铜绿假单胞菌（14.71%）,金黄色葡萄球菌（9.80%）,臭鼻克雷伯菌（8.82%）等;检出细菌并白色念珠菌感染者3例,单纯支原体感染者3例,细菌并支原体感染者8例。婴儿重症肺炎分离的病原菌对青霉素类和第一、二代头孢菌素类抗生素耐药率高,且多重耐药现象严重,其对耐酶的第三代头孢菌素保持高度的敏感性。结论治疗婴儿重症肺炎并急性心力衰竭时应联合用药。同时监测本地区婴儿重症肺炎的病原学流行分布及药物敏感性变化非常重要。

INFANTS WITH SEVERE PNEUMONIA COMPLICATING HEART FAILURE： AN ETIOLOGY ANALYSIS OF 148 CASES

Objective To investigate the etiology of infants with severe pneumonia complicating heart failure treated in intensive care unit of Qingdao Children＇s Hospital and the drug sensitivity of the pathogens. Methods This study was done in 148 infants with the disease agreed with the diagnostic criteria of infant pneumonia issued in ]987. The phlegm specimens were detected bacteriologically, and throat-swab specimens detected for mycoplasma pneumonia by polymerase chain reaction. The tests were carried out based on the National Committee for Clinical Laboratory Standards （NCCLS） of the United States of America. Results Gram negative bacteria were the main pathogenic bacteria, of which, E. coli ranged the first （25.49%）, the second was Streptococcus pneumoniae （17.64%）, and then in the following order, P. aeruginos （14.71%）, Staphylococcus aureus （9.80%）, and Klebsiella （8.82%）. Mycoplasma was found only in three samples, mycoplasma combined with bacteria in eight, fungi combined with bacteria in three. Gram negative bacteria were highly sensitive to third generation cephalosporin tolerated to enzyme. Conclusion A combined medication should be used for children with severe pneumonia complicated by heart failure, and it is also important to monitor the epidemiology and detect drug sensitivity of the pathogens.