CAJ | 학술논문

目的：探讨儿科重症监护病房( PICU)患儿下呼吸道感染的病原微生物分布及耐药性，为临床抗感染治疗和合理使用抗感染药物提供依据。方法选择2012年1月-2013年12月北京军区总医院PICU收治的先天性心脏病术后诊断为下呼吸道感染的患儿88例，对送检的痰标本进行了培养及药敏试验，并对分离出的病原菌进行分析。结果88例送检痰标本432份，分离出46株病原微生物，检出率为10.65%，其中革兰阴性菌43株，占93.48%；革兰阳性菌2株，占4.35%；真菌1株，占2.17%。检出率居前5位的革兰阴性菌中肺炎克雷伯菌、铜绿假单胞菌对氨苄西林、氨苄西林钠/舒巴坦钠、头孢曲松钠等耐药率为100.00%；铜绿假单胞菌对亚胺培南的耐药率为100.00%；鲍曼不动杆菌只对头孢哌酮钠/舒巴坦钠、头孢曲松钠保持100.00%的敏感性，对其他药物呈现出多重耐药和泛耐药趋势；大肠埃希菌对氨苄西林、哌拉西林钠、头孢呋辛钠、头孢曲松钠等耐药率为100.00%；嗜麦芽窄食单胞菌对头孢他啶和替卡西林钠-克拉维酸钾耐药率为50.00%。结论加强对PICU先天性心脏病患儿术后呼吸道管理，及时掌握并监测患儿下呼吸道感染病原微生物的分布及耐药性，根据药敏试验结果合理选择抗感染药物，对患儿术后的康复有重要意义。
목적：탐토인과중증감호병방( PICU)환인하호흡도감염적병원미생물분포급내약성，위림상항감염치료화합리사용항감염약물제공의거。방법선택2012년1월-2013년12월북경군구총의원PICU수치적선천성심장병술후진단위하호흡도감염적환인88례，대송검적담표본진행료배양급약민시험，병대분리출적병원균진행분석。결과88례송검담표본432빈，분리출46주병원미생물，검출솔위10.65%，기중혁란음성균43주，점93.48%；혁란양성균2주，점4.35%；진균1주，점2.17%。검출솔거전5위적혁란음성균중폐염극뢰백균、동록가단포균대안변서림、안변서림납/서파탄납、두포곡송납등내약솔위100.00%；동록가단포균대아알배남적내약솔위100.00%；포만불동간균지대두포고동납/서파탄납、두포곡송납보지100.00%적민감성，대기타약물정현출다중내약화범내약추세；대장애희균대안변서림、고랍서림납、두포부신납、두포곡송납등내약솔위100.00%；기맥아착식단포균대두포타정화체잡서림납-극랍유산갑내약솔위50.00%。결론가강대PICU선천성심장병환인술후호흡도관리，급시장악병감측환인하호흡도감염병원미생물적분포급내약성，근거약민시험결과합리선택항감염약물，대환인술후적강복유중요의의。
Objective To explore the distribution and drug resistances of the pathogenic bacteria in children with lower respiratory infection in pediatric intensive care unit ( PICU) of department of cardiac surgery, and to provide evidence for clinical anti-infective therapy and reasonable use of antibacterials. Methods A total of 88 children with lower respiratory infection after operation for congenital heart disease during January 2012 and December 2013 in the PICU of the department of cardiac surgery were selected, and sputum samples were taken for cultivation and drug sensitiv-ity test, and then pathogenic bacteria were isolated and analyzed. Results A total of 46 pathogenic microorganisms were isolated from 432 sputum samples in the 88 children, and the isolating rate was 10. 65%, in which 43 strains were gram-negative bacteria, which accounted for 93. 48%;2 strains were gram-positive bacteria, which accounted for 4. 35%;1 was fungus, which accounted for 2. 17%. The resistance rates of the top 5 detected gram-negative bacteria such as kleb-siella pneumoniae and pseudomonas aeruginosa to Ampicillin, Ampicillin/Sulbactam Sodium and Ceftriaxone Sodium were 100. 00%;the resistance rate of pseudomonas aeruginosa to Imipenem was 100. 00%;acinetobacter baumannii was 100. 00% sensitive to Cefoperazone Sodium/Sulbactam Sodium and Ceftriaxone Sodium, but multidrug resistance and pan-drug resistance to other drugs were observed;the resistance rates of escherichia coli to Ampicillin, Piperacillin Sodi-um , Cefuroxime Sodium and Ceftriaxone Sodium were 100. 00%;and the resistance rates of stenotrophomonas maltophilia to Ceftazidime and Ticarcillin Sodium-Clavulanate Potassium were 50. 00%. Conclusion It is of vital significance for postoperative rehabilitation of children with congenital heart disease in PICU of department of cardiac surgery to strengthen postoperative respiratory tract administration, quickly control and monitor the distribution and drug resistances of the path-ogenic bacteria of lower respiratory infection and reasonably select anti-infective agents based on the drug sensitivity test results.