重症监护病房婴幼儿重症肺炎细菌学监测及临床分析

目的探讨痰液细菌培养对婴幼儿重症肺炎临床治疗的指导作用。方法对PICU270例重症肺炎婴幼儿用一次性无菌吸痰管负压吸取下呼吸道痰液,将合格痰标本进行细菌培养和药敏分析。结果痰培养检出细菌167株,阳性率为61.85%。其中革兰阳性球菌81株(48.50%),革兰阴性杆菌79株(47.31%),真菌7株(4.19%);以化脓性链球菌41株(24.55%)]和肺炎克雷伯杆菌39株(23.35%)]为主,其次为大肠埃希菌24株(14.37%)。革兰阳性球菌对青霉素、红霉素、克林霉素耐药率较高,对万古霉素、利福平耐药率低;革兰阴性杆菌对氨苄西林/舒巴坦、头孢噻吩耐药率较高,对亚胺培南、环丙沙星耐药率低。痰培养阳性和阴性组年龄、性别、器官功能障碍发生情况、白细胞计数和白细胞升高例数方面比较,均无显著差异(Pa>0.05);痰培养革兰阳性球菌组与革兰阴性杆菌组比较,胃肠功能障碍和微循环障碍发生率差异有显著性(Pa<0.05)。入院时所用抗生素根据痰培养结果按敏感、未查药敏、耐药分组,疗效比较差异有显著性(Pa<0.01)。抗生素治疗疗效差患儿,据痰培养结果调整抗生素,82.6%患儿3d后病情好转。结论对严重肺部感染,特别是入院前选用三代头孢治疗无效患儿,可首选亚胺培南,必要时选用万古霉素;并胃肠功能和微循环障碍提示革兰阴性杆菌感染可能性大;重症肺炎从临床表现、白细胞计数、X线特征等难以区分细菌和非细菌感染;痰液细菌培养检出率高,能在一定程度上提示肺部感染病原菌,是细菌性肺炎重要的病原检测手段之一。

Bacteriology and Clinical Analysis of Severe Pneumonia in Infants and Young Children in Pediatric Intensive Care Unit

Objective To explore the value of sputum bacterial culture in treatment of severe pneumonia in infants and young children.Methods Two hundred and seventy infants and young children with severe pneumonia of pediatric intensive care unit(PICU) were collected.Lower respiratory tract sputum was sucked by disposable sterile suction tube in underpressure,and eligible sputum samples were detected by bacterial culture and sensitivity analysis.Results One hundred and sixty-seven bacterial strains were obtained from sputum culture,with a positive rate of 61.85%,Gram-positive cocci in 81 strains(48.50%),Gram-negative bacilli in 79 strains(47.31%),fungi in 7 strains(4.19%);Suppurative Streptococcus and Klebsiella pneumoniae were primary pathogens,in 41 strains(24.55%) and 39 strains(23.35%),respectively.Escherichia coli was the next one,in 24 strains(14.37%);Gram-positive cocci had a high resis-tance rate for penicillin,erythromycin and clindamycin,but the resistance rate for vancomycin and rifampicin was low;Gram-negative bacilli had a high resistance rate for Ampicllin sulbactam and Cefalotin,but the resistance rate for imipenem,ciprofloxacin was low.Compared to negative groups,positive sputum culture group had no significant difference in age-sex distribution,organ dysfunction,and account of WBC and leukocytotic cases(Pa>0.05);Compared to Gram-negative bacilli group of sputum culture,Gram-positive cocci group had significant diffe-rence in the incidence of gastrointestinal dysfunction and microcirculatory disorders(Pa<0.05);Antibiotics used at admission were divided into 3 groups including sensitive,non-detected,resistive groups according to the results of sputum culture.Comparing in three groups,there were significant difference in the effect of treatment(Pa<0.01).Antibiotics of patients with poor effect were adjusted by the results of sputum culture,then 82.6% of patients improved after 3 days.Conclusions Imipenem can be the preferred antibiotics for those patients with serious lung infection,especially those already receives third-generation cephalosporins but without effect,if necessary,we can select vancomycin;Gram-negative bacilli maybe the pathogen of infection when patients are complicated with gastrointestinal dysfunction and microcirculatory di-sorders.It is difficult to distinguish bacterial infections from non-bacterial infections for severe pneumonia only by clinical symptoms,leukocyte count,X-ray characteristics etc;High detection rate of sputum bacterial culture can clew the pathogen of lung infection in a certain extent.And sputum bacterial culture is an important technique to detect the pathogens of bacteroidal pneumonia.