婴儿先天性心脏病术后呼吸机相关性肺炎致病菌及耐药性分析  

Epidemiology of ventilator-associated pneumonia in infants after cardiac surgery

作　　者：谈林华[1] 朱雄凯[1] 俞建根[1] 舒强[1] 张泽伟[1] 李建华[1] 何小军[1] 

机构地区：[1]浙江大学医学院附属儿童医院ICU,杭州310003

出　　处：《中华急诊医学杂志》2005年第3期225-228,共4页Chinese Journal of Emergency Medicine

基　　金：浙江省科技厅基金 ( 2 0 0 3C3 3 0 2 2 );浙江省教育厅基金 ( 2 0 0 2 0 780 )

摘　　要：目的　研究婴儿先天性心脏病 (先心病 )术后呼吸机相关性肺炎 (ventilator -associatedpneumonia ,VAP)的致病菌分布和耐药性及变化趋势 ,为正确选择抗生素提供依据。方法　回顾性分析 1999年 6月至 2 0 0 2年 6月本院 311例婴儿先心病 (根据病情分为复杂先心病组和单纯先心病组 )术后下呼吸道分泌物所有分离的细菌、真菌菌株及其耐药性。结果　 (1) 6 7例 (2 1 5 % )婴儿术后发生VAP ,复杂先心病组VAP的发生率比单纯先心病组高 (χ2 =2 2 4 7,P <0 0 0 0 1) ,且以迟发VAP较多 (χ2 =6 0 2 ,P =0 0 14 )。 (2 )分离出致病菌 79株 ,革兰阴性 (G-)菌为主 ,其次为真菌和革兰阳性 (G+ )菌。G-菌中多见鲍曼不动杆菌、铜绿假单胞菌、脑膜炎败血黄色杆菌等 ;G+ 菌常见金黄色葡萄球菌和表皮葡萄球菌。真菌以白色念珠菌为主。 (3)G-菌对亚胺培南 /西司他丁、头孢哌酮 /舒巴坦、哌拉西林 /他唑巴坦、环丙沙星、阿米卡星、头孢他啶较敏感 ,但其中的嗜麦芽黄单胞菌、脑膜炎败血黄色杆菌对亚胺培南 /西司他丁耐药率高。产超广谱 β -内酰胺酶菌主要为肺炎克雷伯菌和大肠埃希菌 ,对一代、二代、三代、四代头孢菌素及青霉素类抗生素耐药 ,但对亚胺培南 /西司他丁的敏感率为 10 0 %。G+ 菌对万古霉素敏感率为 10 0 %Objective To study the epidemiology of ventilator-associated pneumonia(VAP) in infants after cardiac surgery,and to study the changes of pathogenic bacteria distribution and antibiotic resistance.Methods Data were collected between June 1999 and June 2002 from 311 infants who suflered from congenital heart disease and underwent open-heart surgery in our hospital. The cases were divided into complex congenital heart disease (CHD) group and simple CHD group according to the severity of pathogenic condition. The distribution and antibiotic resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed retrospectively.Results (1) Of 311 infants , 67 (21.5%) developed VAP after cardiac surgery. The incidence of VAP was more frequent in infants with complex CHD than with simple CHD (43% vs 15.9%, χ 2=22.47,P<0.0001) . The proportion of late-onset VAP was higher in complex CHD patients (χ 2=6.02 P=0.014) .(2) 79 pathogenic microbial strains were isolated. Gram-negative bacilli (G -) were the most,followed by fungi and Gram-positive cocci (G +). The main G - were acinetobacter baumanii, pseudomonas aeruginosa. The main G + were staphylococcus aureus and staphylococcus epidermidis. The main fungi were candida albicans. (3) Most G - were sensitive to imipenem, cefoperazone-sulbactum, piperacillin-tazobactam, ciprofloxacin, amikacin, ceftazidime.The bacteria producing extended spectrum β-lactamases (ESBLs) were mainly from klebsiella pneumoniae and Escherichia coli.The susceptibility of ESBLs-producing strains to imipenem was 100%.The susceptibility of G + to vancomycin was 100%.(4)From 1999 to 2002 in infants who suffered from VAP after open-heart surgery , there was a trend of increasing frequency of multiresistant G - such as acinetobacter baumanii, pseudomonas aeruginosa and klebsiella pneumoniae . However,no remarkable changes of distribution were found in Ga+ and fungi in the 3-year period . (5) Early-onset VAP were frequently caused by hemophilus infl

关 键 词：VAP 术后 致病菌 婴儿 西司他丁 呼吸机相关性肺炎 鲍曼不动杆菌 真菌 病原菌 青霉素类抗生素 

分 类 号：R726.5[医药卫生—儿科]