摘要
目的了解儿童难治性肺炎患儿感染的病原体及其耐药情况。方法对深圳市儿童医院2008年5月—2014年12月收治的难治性肺炎住院患儿行支气管镜术,并对支气管肺泡灌洗液(BALF)进行病原体培养及耐药性检测。结果共纳入1 693例难治性肺炎患儿,226例患儿BALF标本培养病原体273株,革兰阳性菌占38.10%(104/273),其中肺炎链球菌71株、金黄色葡萄球菌23株;革兰阴性菌占58.24%(159/273),包括副流感嗜血杆菌44株,肺炎克雷伯菌28株,大肠埃希菌19株,铜绿假单胞菌17株;检出真菌10株,其中8株为白假丝酵母菌。肺炎链球菌对喹诺酮类、头孢曲松和头孢噻肟敏感性较高。耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌的26.32%。副流感嗜血杆菌产β-内酰胺酶的菌株占32.72%,肺炎克雷伯菌中产β-内酰胺酶的菌株占62.96%。结论难治性肺炎患儿病原体主要为肺炎链球菌、副流感嗜血杆菌等,经验性治疗应重点覆盖上述病原体,疗效不佳时应考虑耐药可能,并及时根据培养和药敏结果进行目标性治疗。
Objective To evaluate pathogens and antimicrobial resistance of pathogens causing refractory pneumonia in children.Methods Children with refractory pneumonia who admitted to a hospital between May 2008 and December 2014 were performed bronchoscopy,and bronchoalveolar lavage fluid（BALF）were performed bacterial culture and antimicrobial resistance testing.Results 1 693 patients were recruited in the study,273 bacterial isolates were isolated from BALF specimens of 226 children,gram-positive bacteria accounted for 38.10%（104/273）,the main gram-positive bacteria were Streptococcus pneumoniae（n=71）and Staphylococcus aureus（n=23）;gram-negative bacteria accounted for 58.24%（159/273）,including 44 isolates of Haemophilus parainfluenzae,28 Klebsiella pneumoniae,19 Escherichia coli,and17 Pseudomonas aeruginosa;10isolates of fungi were also detected,8 of which were Candida albicans.The sensitivity of Streptococcus pneumoniae to quinolones,ceftriaxone and cefotaxime were high.Methicillin-resistant Staphylococcus aureus（MRSA）positive rate was 26.32%.ESBLs-producing rate of Haemophilus parainfluenzae and Klebsiella pneumoniae was32.72% and 62.96%respectively.Conclusion The major pathogens causing refractory pneumonia were Streptococcus pneumoniae and Haemophilus parainfluenzae,empirical treatment should be conducted accordingly,antimicrobial resistance should be considered if therapeutic effect is poor,and targeted therapy should be performed according to cultured results and antimicrobial susceptibility testing result.
出处
《中国感染控制杂志》
CAS
北大核心
2015年第6期379-382,共4页
Chinese Journal of Infection Control
基金
深圳病原体高通量基因测序技术工程实验室深发改[2014]1712号
关键词
支气管肺泡灌洗液
支气管镜
难治性肺炎
抗药性
微生物
病原学
bronchoalveolar lavage fluid
bronchoscope
refractory pneumonia
drug resistance
microbial
aetiology
