CAJ | 학술논문

目的了解重症社区获得性肺炎(community-acquired pneumonia,CAP)患儿病原微生物分布情况及细菌的耐药情况.方法选取2011年3月至2012年2月在我院PICU住院的193例重症社区获得性肺炎患儿,取痰液送细菌培养和药敏试验,应用聚合酶链荧光定量技术测定肺炎支原体、沙眼衣原体基因片段.同时采用荧光免疫法检测鼻咽分泌物的病毒抗原.结果 193例重症CAP患儿中,痰细菌培养阳性96例(49.7％),前4位细菌分别是肺炎克雷白杆菌、金黄色葡萄球菌、大肠埃希菌、肺炎链球菌.革兰阴性菌对氨苄西林、头孢唑啉、头孢曲松、头孢他啶、复方磺胺甲唑耐药率较高,对哌拉西林/他唑巴坦、亚胺培南、环丙沙星、左旋氧氟沙星、阿米卡星耐药率低；革兰阳性菌对青霉素和红霉素耐药率高,对万古霉素敏感率高.病毒检测阳性53例(27.5％,53/193),且81.1％的患儿为1岁以内的婴儿,其中,以呼吸道合胞病毒感染最多,其次为腺病毒、流感病毒A.痰检肺炎支原体阳性4例(2.1％,4/193),沙眼衣原体阳性3例(1.6％,3/193).混合感染23例(11.9％,23/193).未检出病原菌14例(7.2％,14/193).结论本地区重症CAP的病原以细菌居首位,病毒次之；细菌感染的重症肺炎初始经验用药宜选用哌拉西林/他唑巴坦或碳青霉烯类抗生素联合万古霉素.
목적 료해중증사구획득성폐염(community-acquired pneumonia,CAP)환인병원미생물분포정황급세균적내약정황.방법 선취2011년3월지2012년2월재아원PICU주원적193례중증사구획득성폐염환인,취담액송세균배양화약민시험,응용취합매련형광정량기술측정폐염지원체、사안의원체기인편단.동시채용형광면역법검측비인분비물적병독항원.결과 193례중증CAP환인중,담세균배양양성96례(49.7％),전4위세균분별시폐염극뢰백간균、금황색포도구균、대장애희균、폐염련구균.혁란음성균대안변서림、두포서람、두포곡송、두포타정、복방광알갑서내약솔교고,대고랍서림/타서파탄、아알배남、배병사성、좌선양불사성、아미잡성내약솔저；혁란양성균대청매소화홍매소내약솔고,대만고매소민감솔고.병독검측양성53례(27.5％,53/193),차81.1％적환인위1세이내적영인,기중,이호흡도합포병독감염최다,기차위선병독、류감병독A.담검폐염지원체양성4례(2.1％,4/193),사안의원체양성3례(1.6％,3/193).혼합감염23례(11.9％,23/193).미검출병원균14례(7.2％,14/193).결론 본지구중증CAP적병원이세균거수위,병독차지；세균감염적중증폐염초시경험용약의선용고랍서림/타서파탄혹탄청매희류항생소연합만고매소.
Objective To study the distribution of pathogenic spectrum in children with severe community-acquired pneumonia(CAP) and bacteria antibiotic resistance.Methods One hundred and ninety-three children with severe CAP were enrolled from Mar 2011 to Feb 2012.Sputum specimens were collected for bacterial culture and drug sensitive test.Meanwhile mycoplasma pneumonia and chlamydia trachomatis were detected by fluorescent quantitative polymerase enzyme technology.Antigen of virus were detected by immunofluorescence assay.Results A total of 96 cases (49.7％) were bacteria positive in 193 children with severe CAP.The top four bacteria strains were klebsiella pneumoniae,staphylococcus aureus,escherichia coli and streptococcus pneumoniae.Most of gram-negative bacteria were resistant to ampicillin,cefazolin,ceftriaxone,ceftazidime,and compound sulfamethoxazole,but were sensitive to piperacillin/tazobactam,imipenem,ciprofloxacin,levofloxacin,amikacin.Gram-positive bacteria were resistant to penicillin and erythromycin,but sensitive to vancomycin.Fifty-three cases (27.5 ％,53/193) were virus Positive,81.1％ of which were less than 1 year old.Respiratory syncytial virus accounted for the most prevalent pathogen,followed by adenovirus,influenza virus A.Mycoplasma pneumoniae were positive in 4 patients (2.1％,4/193),chlamydia trachomatis were positive in 3 patients (1.6％,3/193).Mixed infection was found in 23 cases (11.9％,23/193).There were 14 cases (7.2％,14/193) with undetected pathogens.Conclusion Bacterium is the major pathogen in children with severe CAP and the virus is the second.The initial antibiotics administration of piperacillin/tazobactam or carbapenem and vancomycin should be chosen for severe bacteria pneumonia.