婴幼儿先天性心脏病术后呼吸机相关性肺炎病原菌分布及药敏变迁  

Pathogenic bacteria distribution and clinical analysis of ventilator-associated pneumonia in infantsand young children with congenital heart disease after surgery

作　　者：汪力[1] 谢艳丽[1] 龚立[1] 皮名安[1] 王涛[1] 

机构地区：[1]武汉市儿童医院心脏外科,武汉430016

出　　处：《中华急诊医学杂志》2013年第4期356-361,共6页Chinese Journal of Emergency Medicine

摘　　要：目的调查武汉市儿童医院婴幼儿先天性心脏病术后呼吸机相关性肺炎病原菌分布及耐药情况，为临床合理使用抗菌药物提供依据。方法回顾性分析2010年1月至2012年11月武汉市儿童医院心脏外科婴幼儿先天心脏病术后并发呼吸机相关相关性肺炎病例，对此类患儿分离出的病原菌，采用VITEK2Jr全自动细菌鉴定及药敏分析系统鉴定细菌类别，纸片扩散（K2B）法进行药敏试验。对药敏结果采用WHONET5．0系统软件进行分析。结果2010年检出16株病原菌，革兰氏阴性菌9株（前两位是肺炎克雷伯杆菌18．75％，鲍曼氏不动杆菌12．5％）；革兰氏阳性球菌6株（链球菌18．75％为主），真菌1株。2011年检出32株病原菌，革兰氏阴性菌24株（前三位是鲍曼氏不动杆菌31．25％，肺炎克雷伯杆菌25％，铜绿假单胞菌6．25％），革兰氏阳性球菌8株（肠球菌12．5％，链球菌6．25％）。2012年检出42株病原菌，革兰氏阴性菌38株（肺炎克雷伯杆菌33．33％，鲍曼氏不动杆菌26．19％，铜绿假单胞菌21．42％），革兰氏阳性球菌4株（肠球菌4．76％为主）。鲍曼氏不动杆菌对对阿米卡星、左氧氟沙星敏感率最高，但对美罗培南、亚胺培南耐药。肺炎克雷伯杆菌对阿米卡星、左氧氟沙星敏感最高，对头孢哌N／舒巴坦、美罗培南、亚胺培南、复方新诺明、环丙沙星耐药。铜绿假单胞菌自2012年起仅对左氧氟沙星、哌拉西彬他唑巴坦敏感。革兰氏阳性球菌所占比例逐年降低，多以肠球菌及链球菌为主，葡萄球菌逐年减少，但未发现万古霉素耐药菌株。结论婴幼儿先心病术后呼吸机相关性肺炎优势病原菌为革兰氏氏阴性菌，以肺炎克雷伯菌、鲍曼氏不动杆菌和铜绿假单胞菌为主，且耐药性呈增加趋势，临床应依据细菌病原学及耐药性资料，合理选择抗菌药物。Objective To investigate pathogen bacteria distribution and clinical analysis of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery for guiding the rational clinical use of antimicrobial drugs. Methods The clinical data of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery were retrospectively analyzed for microbiologically documented infection. Bacterial identification was performed in an automatic VITEK2Jr expression system and antimicrobial susceptibility testing by Kirby2Bauer method. The results of antimicrobial susceptibility testing were performed in WHONET 5.0 system software. Results There were 16 strains of pathogenic bacteria in 2010, Gram-negative bacteria 9 stains （KlebsieUa pneumoniae 18.75%, Acinetobacter baummannii 12. 5% ）, gram positive coccus 6strains （ Streptococcus 18.75% ）, Fungi 1 strain. There were 32 strains of pathogenic bacteria in 2011, Gram-negative bacteria 24 stains （ Acinetobacter baummannii 31.25% , Klebsiella pneumoniae 25% , Pseudomonas aeruginosa 6. 25% ） ,gram positive coccus 8 strains （ Enterococcus 12. 5% , Streptococcus 6. 25% ）. There were 42 strains of pathogenic bacteria in 2012, Gram-negative bacteria 38 stains （Acinetobacter baummannii 26. 19%, Klebsiella pneumoniae33.33%, Pseudomonas aeruginosa 21.42% ）, gram positive coccus 4 strains （ Enterococcus 4.76% ）. Acinetobacter baummannii remained highly sensitive to Amikacin and Levofloxacin, highly resistant to Meropenem, Imipenem, Klebsiella pneumonia remained highly sensitive to Amikacin and Levofloxacin, highly resistant to Cefoperazone/Sulbactam, Meropenem, Imipenem, trimethoprim-sulfamethoxazole, Ciprofloxacin. Pseudomonas aeruginosa only remained sensitive to Levofloxacin and Piperacillin/Tazobactam. Gram-positive cooci proportion in pathogenic bacteria decreased year by year, Streptococcus and Enterococcus had major proportion in Gram-positive cooci, Staphylococci decreased, There wa

关 键 词：先天性心脏病 婴幼儿 呼吸机相关性肺炎 耐药性 机械通气 重症监护室 流行病学 病原菌 

分 类 号：R446.5[医药卫生—诊断学]