太原地区儿童医院获得性肺炎流行特征及病原学研究

目的:基于儿童医院获得性肺炎(NP)的严重性和危害性,本研究通过对太原地区儿童医院获得性肺炎流行特征及病原学研究,为儿童医院获得性肺炎的预防和控制提供科学依据。方法:采用调查与统计学方法相结合,对NP患儿的年龄分布、原发疾病、危险因素、病原菌的分布以及对抗生素的耐药性进行分析。结果:太原地区儿童NP患者以1岁以内的婴儿居多,原发疾病主要为先心病、血液病、肾病综合征、神经系统疾病等,发病季节主要为冬春季;病原菌分布以革兰阳性菌占首位,而革兰阳性菌和真菌的构成呈逐年增长趋势。主要革兰阳性菌对青霉素、红霉素高度耐药,对万古霉素高度敏感,主要革兰阴性菌对头孢菌素较高耐药,对亚胺培南、头孢哌酮/舒巴坦敏感性较高。结论:小儿NP发生的可能因素主要为:年龄因素(婴儿)、免疫功能低下者、原发基础疾病严重者、实施心胸外科和骨科等外科手术以及环境因素、医务人员防范意识等;可参照本研究结果对儿童NP进行预防、控制和治疗。

The study on the epidemic characteristics and etiology of children with nosocomial pneumonia in Taiyuan

Objective:Owing to the severity and harmfulness of children's nosocomial pneumonia,this paper offers scientific basis for prevention and control of children's NP through the study on epidemic characteristics and etiology of children's NP in Taiyuan.Methods:A retrospective study was performed on consecutive children patients with NP in Children's Hospital of Shanxi between January 2003 and December 2005.The age distribution of children with NP,the department distribution,the underlying disease,the attack season,the distribution of pathogen and the antimicrobial resistance etc were investigated.Results:Most of the children NP patients were below 1 year old,main underlying diseases were:congenital heart disease,blood disease,disease of nervous system,chromosome deformity,low weight of premature delivery,the attack seasons were winter and spring.Gram-positive bacteria occupied the first place,main gram-positive bacteria were highly resistant to penicillin and erythromycin,but extremely sensitive to vancomycin.Main gram-negative bacteria were able to resistance to cephalosporin,yet sensitive to imipenem and cefoperazone/sulbactam.Conclusion:The close attention shuld be paid to the risk factors of NP in children,including infant,low immunological function,serious underlying disease,surgery patient,environmental factor and the prevent consciousness of medical worker etc.According to the result of study,the subject of preventing,control and treating children's NP would be done better.