儿童重症肺炎2044例肺泡灌洗液细菌病原学分析  

Bacterial etiology analysis of alveolar lavage fluid in severe pneumonia of 2044 children

作　　者：刘霞[1] 马静[1] 张忠晓[1] 赵凤美[1] 牛铁环[1] 闫秀丽[1] 孔德晓[2] 孟晨[1] 

机构地区：[1]山东大学齐鲁儿童医院呼吸介入科,山东济南250022 [2]山东大学第二医院血液科,山东济南250033

出　　处：《中国实用儿科杂志》2014年第6期438-441,共4页Chinese Journal of Practical Pediatrics

基　　金：济南市2010年科学技术发展计划第十九批项目济科计[2010]37号(201019025);山东省自然科学基金青年基金项目(ZR2011HQ042);山东大学2010年自主创新基金(交叉学科培育项目)(2010JC006)

摘　　要：目的支气管肺泡灌洗液(BALF)培养及微生物敏感性试验(简称药敏)调查儿童重症肺炎的病原菌及耐药率。方法对山东大学齐鲁儿童医院2009年1月至2011年12月收治的2044例重症肺炎住院患儿行支气管镜下肺泡灌洗术,并对支气管肺泡灌洗液进行细菌培养及药敏分析。结果肺泡灌洗液培养出病原菌247例,感染优势菌为肺炎克雷伯菌49例、大肠埃希菌44例、阴沟肠杆菌23例、铜绿假单胞菌17例;肺炎链球菌21例;金黄色葡萄球菌11例;溶血葡萄球菌9例。药敏试验结果显示:青霉素G、氨苄西林、阿莫西林克拉维酸、头孢呋辛、红霉素、苯唑西林耐药率均超过50%。所测菌株对头胞哌酮舒巴坦未见耐药发生。结论支气管镜下肺泡灌洗液细菌培养为较好的下呼吸道病原菌检测方式,该组重症肺炎以革兰阴性菌感染为主,早期检测病原菌和耐药性对提高疗效和改善预后是非常重要的。Objective To investigate the distribution and antibiotic resistance of bacteriosis in alveolar lavage fluid in children＇ s severe pneumonia. Methods The strains isolated from alveolar lavage fluid in 2044 cases of severe pneumonia in children from Jan.2009 to Dec.2011 were retrospectively analyzed. Results In 2044 samples, 247 strains were obtained. The dominant pathogenic bacteria were ： 49 strains of Klebsiella pneumoniae, 44 Escherichia coli, 23 Eutero-bacter cloacae, 17 Psendomonas aeruginosa, 21 Streptococcus pneumoniae, 11 Staphylococcus aureus and 9 Staphylo-coccus haemolyticus. The obtained strains had severe drug resistance to some antibiotics ,which were penicillin G, ampicillin, amoxicillin clavulanic acid, cefuroxime, erythrocin, and oxacillin, but not to cefoperazone and sulbactam sodium. Conclusion The germiculture of alveolar lavage fluid by bronchoscopes is a better way for detecting pathogenic bacteria in the lower respiratory tract. The main pathogenic bacteria of the pediatric severe pneumonia are Gram-negative bacilli, and it is important to early detect pathogenic bacteria and depress drug resistance improving curative effect and prognosis.

关 键 词：支气管肺泡灌洗液 肺炎 重症 细菌检测 微生物敏感性试验 

分 类 号：R72[医药卫生—儿科]