脑性瘫痪儿童医院获得性肺炎的病原菌分布及耐药性分析

目的了解脑性瘫痪(简称脑瘫)儿童医院获得性肺炎(HAP)的病原菌分布及耐药情况。方法收集2012年1月至2015年5月在本院儿童康复科住院期间感染肺炎的脑瘫患儿402例。结果 402份痰标本中共分离到菌株291株,检出率72.4%,其中革兰阴性菌259株(89.0%),革兰阳性菌26株(8.9%),真菌6株(2.1%)。革兰阴性菌主要为大肠埃希菌(32.6%)、肺炎克雷伯菌(24.4%)和铜绿假单胞菌(14.4%),其中大肠埃希菌和肺炎克雷伯菌主要产超广谱β内酰胺酶(ESBLs,产酶率分别为58.9%、59.2%),产ESBLs菌的平均耐药率为55.5%,对碳青霉烯类抗生素的平均耐药率为5.0%。铜绿假单胞菌的平均耐药率34.9%,对碳青霉烯类抗生素均敏感。结论脑瘫儿童HAP的病原菌以革兰阴性菌"大肠埃希菌、肺炎克雷伯菌"为主,两者产ESBLs菌检出率达58%以上,平均耐药率为55.5%,可指导临床首次经验性选药,以提高脑瘫儿童HAP的治疗有效率。

Pathological bacterial distribution and antibiotic resistance of hospital acquired pneumonia in children with cerebral palsy

Objective To investigate the pathological bacterial distribution and their antibiotic resistance of hospital acquired pneumonia in children with cerebral palsy. Methods Induced sputum was extracted from 402 ca-ses of hospitalized children with cerebral palsy infected hospital acquired pneumonia in children rehabilitation depart-ment from January 2012 to May 2015. Results A total of 291 (72. 4%) strains of bacteria were isolated from in-duced sputum in the 402 children. The Gram-negative strains were detected in 259 strains (89. 0%), and the Gram-positive strains were found in 26 strains ( 8. 9%) in 291 strains. The others were fungal strains ( 6 strains, 2. 1%) . The Gram-negative bacteria included Escherichia coli ( 32. 6%) , Klebsiella pneumoniae ( 24. 4%) , and Pseudomonas aeruginosa (14. 4%). Escherichia coli and Klebsiella pneumoniae could produce extended-spectrumβ-lactamases ( ESBLs) ( The rates of enzyme production were 58. 9% and 59. 2%) . The average rate of antibiotic re-sistance for ESBLs-producing bacteria was 55. 5%, and the average resistance rate to carbapenems was 5. 0%. The average resistance rate to Pseudomonas aeruginosa was 34. 9%, but sensitive to carbapenems. Conclusion Esche-richia coli and Klebsiella pneumoniae are the main pathogenic bacteria causing hospital acquired pneumonia in chil-dren with cerebral palsy. ESBLs-producing bacteria of them accounts for over 58%, and the average rate of antibiotic resistance for ESBLs-producing bacteria is 55. 5%. These results provide a basis for the first empirical clinical use of antimicrobial in children with cerebral palsy and hospital acquired pneumonia.