宝鸡地区小儿重症监护病房(PICU)呼吸机相关性肺炎病原菌的流行病学调查  

Epidemiological investigation of ventilator-associated pneumonia pathogens in children's intensive care unit(PICU) in Baoji area

作　　者：邱燕玲[1] 宋文萍 张丽 汤淑斌[1] 魏升云 韩鹏[1] 汤勉[1] 

机构地区：[1]宝鸡市妇幼保健院儿童重症科,宝鸡721000 [2]渭南市妇幼保健院新生儿科,渭南714000

出　　处：《湖南师范大学学报（医学版）》2017年第5期176-179,共4页Journal of Hunan Normal University(Medical Sciences)

基　　金：基金项目:宝鸡市卫计局科研(NO.2012-52)

摘　　要：目的:探究宝鸡地区小儿重症监护病房(PICU)呼吸机相关性肺炎病原菌的构成和其耐药性,指导该地临床选用抗生素。方法:选取2015年3月~2016年8月于宝鸡地区5家三级甲等医院接受治疗的小儿患者512例,将发生呼吸机相关性肺炎的患者归入感染组,将未发生该病的患者记为对照组,吸取感染组患儿呼吸道分泌物,使用全自动微生物分析仪对致病菌进行培养、分离和鉴定,并且使用药敏实验仪对前五种致病菌进行药物敏感性试验。结果:感染组患者177例,对照组患者335例,发病率为34.5%。分离出病原株100株,其中以革兰阴性菌为主,共63株,占63.0%;革兰阳性菌25株,占25.0%;真菌12株,占12.0%。革兰阴性菌对庆大霉素、氨苄西林、阿莫西林、头孢他啶、头孢噻肟、头孢唑林等抗生素耐药性较高,对阿米卡星、妥布霉素、左氧氟沙星、环丙沙星、头孢咇肟等抗生素耐药性较低;革兰阳性菌对庆大霉素、阿莫西林、头孢他啶、头孢噻肟、头孢唑林等抗生素的耐药性较高,对氨苄西林、阿米卡星、妥布霉素、左氧氟沙星、环丙沙星、头孢咇肟等抗生素耐药性较低。结论:宝鸡地区小儿重症监护病房(PICU)呼吸机相关性肺炎病原菌以革兰阴性菌为主,前五种优势病原菌分别为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、白色假丝酵母菌。在临床上,应根据细菌耐药性研究结果,合理选择治疗药物。Objective To explore the composition and drug resistance of ventilator-associated pneumonia pathogens in the intensive care unit(PICU) of Baoji area, and to guide the clinical selection of antibiotics. Methods 500 cases of pediatric patients were selected from five tertiary hospitals in Baoji area from March 2013 to August 2014. Patients with ventilatorassociated pneumonia were classified into the infection group, the patients who did not develop the disease were recorded as control group, the respiratory secretions of the infected group were drawn, the pathogens were cultured, separated and separated by the automatic microbiological analyzer And the drug sensitivity test was performed on the first five pathogens using a drug susceptibility tester. Results There were 177 patients in the infection group and 323 patients in the control group, the incidence rate was 35.4%.100 strains of pathogenic isolates were isolated, among which 63 were Gram-negative bacteria, accounting for 63.0%. There were 25 strains of Gram-positive bacteria, accounting for 25.0%; 12 strains of fungi, accounting for 12.0%. Gram-negative bacteria on gentamicin, ampicillin, amoxicillin, ceftazidime, cefotaxime, cefazolin and other antibiotic resistance is higher, the amikacin, tobramycin, levofloxacin, ciprofloxacin Starter, cefotaxime and other antibiotic resistance is low; Grampositive bacteria on gentamicin, amoxicillin, ceftazidime, cefotaxime, cefazolin and other antibiotics, high resistance to ampicillin, Mika star, tobramycin, levofloxacin, ciprofloxacin, cefuroxime and other antibiotic resistance is low. Conclusion The first five dominant pathogens are Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Pneumoniae Klein, Pseudomonas aeruginosa, Pseudomonas aeruginosa, Pseudomonas aeruginosa, Pseudomonas aeruginosa, Pseudomonas aeruginosa, Pneumocystis carinii Bacteria, Candida albicans. In clinical practice, we should base on bacterial drug resistance research results, making a reasonable choice of treatment drugs.

关 键 词：呼吸机相关性肺炎 病原菌 流行病学 儿科 

分 类 号：R446.5[医药卫生—诊断学] R725.6[医药卫生—临床医学]