2010～2011年重症手足口病呼吸机相关性肺炎的病原学调查及耐药性分析

目的:分析重症手足口病并发呼吸机相关性肺炎(VAP)的病原菌构成及其耐药性,为临床合理使用抗菌药物提供科学依据。方法:回顾性分析2010年1月～2011年12月我院重症病房收治的重症手足口病发生VAP 31例患儿的痰培养分离病原菌及药敏结果。结果:VAP感染率为31.31%,分离出的54株病原菌均为革兰氏阴性菌,31例患儿VAP感染前三位的菌是铜绿假单胞菌、非发酵革兰氏阴性杆菌、鲍曼不动杆菌。结论:重症手足口病合并VAP致病以革兰氏阴性杆菌为主,可将第3代头孢菌素、磺胺类作为临床治疗手足口病并发VAP铜绿假单胞菌感染的首选药物;单环β-内酰胺类、磺胺类、第三代头孢菌素可作为非发酵革兰氏阴性杆菌感染的首选药物;单环β-内酰胺类、第三代头孢菌素可作为鲍曼不动杆菌感染的首选药物。

Distribution and Drug resistance of pathogens Isolated from severe hand - foot - mouth disease with ventilator - associated pneumonia between 2010 - 2011

Objective ：To explore distribution and drug resistance of pathogens Isolated from severe hand - foot - mouth disease with ventilator - associated pneumonia（VAP） and to provide a reasonable basis for the clinical use of antibiotics. Methods： A total of 31 severe hand - foot - month disease with ventila- tor - associated pneumonia（VAP） patients in ICU in our hospital between January 2010 - December 2011 ,retrospective analysis of sputum culture and drug sensitivity of pathogens isolated. Results：Infection rate was 31.31% ,isolated 54 pathogens were all Gram -negative bacteria. Strains were isolated from se- vere hand - foot - month disease with VAP patients. The first was the Pseudomonas aeruginosa then were non - fermenting gram - negative and acinetobanter baumannii. Conclusions：Severe hand- foot -mouth disease with ventilator- associated pneumonia （VAP） patients were maily gram -negative bacteria, third -generation eephalosporins, sulfonamides, can be the first concurrent drag of choice as a clinical treatment of Pseudomonas anrug/nosa hand ,foot and mouth with（VAP）. Monocyclic 3- lactams ,sulfonamides,third- generation cephalesporins as a non- fermenting gram- negative infection drug of choice. Monocyclic 3 - lactams, third - generation eephalosporins as Acinetobacter infection drug of choice.