中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
8期
504-507
,共4页
呼吸机相关性肺炎%痰液%耐药%儿童
呼吸機相關性肺炎%痰液%耐藥%兒童
호흡궤상관성폐염%담액%내약%인동
Ventilator-associated pneumonia%Sputum%Drug resistance%Children
目的 分析本院PICU呼吸机相关性肺炎(ventilator associated pneumonia,VAP)深部痰液病原菌分布及耐药性变迁,指导VAP的早期经验性抗生素应用.方法 2009年1月至2013年12月浙江大学附属儿童医院符合VAP诊断标准的121例在PICU呼吸机治疗的患儿,通过封闭式吸痰收集其深部痰液,采用W1TEK60微生物全自动细菌鉴定仪进行细菌鉴定,采用Kirby-Bauer法进行药物敏感试验,并对特殊耐药菌进行鉴定.结果 PICU符合条件的痰标本共分离出病原菌127株,革兰阴性菌64.57％ (82/127),其中以鲍曼不动杆菌、大肠埃希菌、嗜麦芽窄食单胞菌、肺炎克雷白杆菌、铜绿假单胞菌最常见,所占比例分别为25.61％ (21/127)、20.27％(17/127)、20.27％ (17/127)、16.22％(12/127)、9.46％(11/127),其对β内酰胺类抗生素的耐药性达77.62％.革兰阳性菌29.92％(38/127),其中表皮葡萄球菌10株、金黄色葡萄球菌6株,除对万古霉素和利奈唑胺仍敏感外,对头孢菌素以及氨基糖苷类抗生素的耐药率很高.真菌占5.51％ (7/127).结论 PICU患儿VAP深部痰培养仍以革兰阴性菌为主,其耐药性较强,特别是产超广谱β内酰胺酶的菌株对β内酰胺类抗生素的耐药性;革兰阳性菌以葡萄球菌为主.加强VAP的综合防治和抗生素的合理使用是降低感染和细菌耐药的重要保证.
目的 分析本院PICU呼吸機相關性肺炎(ventilator associated pneumonia,VAP)深部痰液病原菌分佈及耐藥性變遷,指導VAP的早期經驗性抗生素應用.方法 2009年1月至2013年12月浙江大學附屬兒童醫院符閤VAP診斷標準的121例在PICU呼吸機治療的患兒,通過封閉式吸痰收集其深部痰液,採用W1TEK60微生物全自動細菌鑒定儀進行細菌鑒定,採用Kirby-Bauer法進行藥物敏感試驗,併對特殊耐藥菌進行鑒定.結果 PICU符閤條件的痰標本共分離齣病原菌127株,革蘭陰性菌64.57％ (82/127),其中以鮑曼不動桿菌、大腸埃希菌、嗜麥芽窄食單胞菌、肺炎剋雷白桿菌、銅綠假單胞菌最常見,所佔比例分彆為25.61％ (21/127)、20.27％(17/127)、20.27％ (17/127)、16.22％(12/127)、9.46％(11/127),其對β內酰胺類抗生素的耐藥性達77.62％.革蘭暘性菌29.92％(38/127),其中錶皮葡萄毬菌10株、金黃色葡萄毬菌6株,除對萬古黴素和利奈唑胺仍敏感外,對頭孢菌素以及氨基糖苷類抗生素的耐藥率很高.真菌佔5.51％ (7/127).結論 PICU患兒VAP深部痰培養仍以革蘭陰性菌為主,其耐藥性較彊,特彆是產超廣譜β內酰胺酶的菌株對β內酰胺類抗生素的耐藥性;革蘭暘性菌以葡萄毬菌為主.加彊VAP的綜閤防治和抗生素的閤理使用是降低感染和細菌耐藥的重要保證.
목적 분석본원PICU호흡궤상관성폐염(ventilator associated pneumonia,VAP)심부담액병원균분포급내약성변천,지도VAP적조기경험성항생소응용.방법 2009년1월지2013년12월절강대학부속인동의원부합VAP진단표준적121례재PICU호흡궤치료적환인,통과봉폐식흡담수집기심부담액,채용W1TEK60미생물전자동세균감정의진행세균감정,채용Kirby-Bauer법진행약물민감시험,병대특수내약균진행감정.결과 PICU부합조건적담표본공분리출병원균127주,혁란음성균64.57％ (82/127),기중이포만불동간균、대장애희균、기맥아착식단포균、폐염극뢰백간균、동록가단포균최상견,소점비례분별위25.61％ (21/127)、20.27％(17/127)、20.27％ (17/127)、16.22％(12/127)、9.46％(11/127),기대β내선알류항생소적내약성체77.62％.혁란양성균29.92％(38/127),기중표피포도구균10주、금황색포도구균6주,제대만고매소화리내서알잉민감외,대두포균소이급안기당감류항생소적내약솔흔고.진균점5.51％ (7/127).결론 PICU환인VAP심부담배양잉이혁란음성균위주,기내약성교강,특별시산초엄보β내선알매적균주대β내선알류항생소적내약성;혁란양성균이포도구균위주.가강VAP적종합방치화항생소적합리사용시강저감염화세균내약적중요보증.
Objective To characterize composition and antibiotic resistance of the pathogens isolated from patients' deep sputum with ventilator-associated pneumonia(VAP) in PICU of our hospital,and give support to the administration of antibiotics early and reasonably in clinic.Methods The study was conducted during the period of January 2009 to December 2013 at PICU of the Children's Hospital of Zhejiang University School of Medicine.One hundred and twenty-one cases of children who conformed to the diagnostic criteria of VAP after treated with ventilator were the object,the endotracheal aspirates were collected and transported to microbiology laboratory within 15 minutes.The pathogens were routinely analyzed and identified with WITEK60 and used Kirby-Bauer method for drug sensitive test,and identified with the special drug-resistant bacteria.Results Among 121 VAP diagnosed patients,127 pathogenic strains isolated from sputum specimen.Gram negative,Gram positive bacteria and fungi accounted for 64.57％ (82/127),29.92％ (38/127)and 5.51％ (7/127) respectively.Acinetobacter baumannii (25.61％,21/127),Escherichia coli (20.27％,17/127),Stenotrophomonas maltophilia (20.27 ％,17/127),Klebsiella pneumoniae (16.22％,12/127) and Pseudomonas aeruginosa (9.46％,11/127) were frequently identified isolates among Gram negative bacteria.The resistant rate of Gram negative bacteria in β lactam antibiotics was 77.62％.Ten strains of Staphylococcus epidermis and 6 strains of Staphylococcus aureus were identified isolates among Gram positive bacteria.Except the sensitive to vancomycin and linezolid,Gram positive bacteria were resistance to cephalosporin and aminoglycosides.All fungi were sensitive to the anti-microbial agents.Conclusion The Gram negative bacteria were more prevalent than Gram positive bacteria and fungi in VAP and show high drug resistance.It is pivotal to administer anti-microbial agents early and reasonably for VAP children.To emphasize surveillance to the antibiotic resistance and grasp the characteristics of the drug resistance are much important to VAP therapy.
