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目的了解3岁以下重症医院获得性肺炎(HAP)患儿深部痰液病原菌分布及其耐药情况。方法选取2007年1月-2008年12月在深圳市儿童医院PICU住院的41例婴幼儿重症HAP患儿,采集患儿深部呼吸道痰液,并对其进行细菌培养和药敏试验。结果 41例HAP患儿中,38例(92.7%)痰培养阳性,检出菌落8种,共分离48株。其中革兰阴性菌43株,革兰阳性菌1株,真菌4株。革兰阴性菌以肺炎克雷伯杆菌、铜绿假单胞菌和大肠埃希菌为主,对氨苄西林、头孢唑啉、头孢曲松、复方磺胺甲唑、呋喃妥因、头孢吡肟、头孢替坦、头孢他啶耐药率较高,对亚胺培南、环丙沙星、哌拉西林/他唑巴坦、左旋氧氟沙星、阿米卡星耐药率低。肺炎克雷伯杆菌和大肠埃希菌产超广谱β内酰胺酶阳性率分别为78.57%和77.78%。革兰阳性菌1株,为金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌阳性。真菌4株,均为酵母菌,其中2株对依曲康唑耐药。结论婴幼儿重症HAP主要是由细菌感染引起,以革兰阴性菌为主,依次为肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌,产超广谱β内酰胺酶阳性率高。对常见第二、三代头孢耐药率高,初始经验用药宜选用哌拉西林/他唑巴坦和碳青霉烯类抗生素。
Objective To understand the distribution and drug resistance of deep sputum pathogens in children with severe hospital-acquired pneumonia (HAP) under 3 years of age. Methods From January 2007 to December 2008, 41 infants with severe HAP inpatients were enrolled in the PICU of Shenzhen Children’s Hospital. The sputum of deep respiratory tract in children was collected and cultured in vitro and susceptibility test. Results Among the 41 cases of HAP, 38 (92.7%) sputum cultures were positive. Eight colonies were detected and 48 were isolated. Among them, 43 strains of Gram-negative bacteria, 1 strain of Gram-positive bacteria and 4 strains of fungi. Gram-negative bacteria Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli-based, ampicillin, cefazolin, ceftriaxone, compound sulfamethoxazole, nitrofurantoin, cefepime, cefotetan , Ceftazidime high rate of resistance to imipenem, ciprofloxacin, piperacillin / tazobactam, levofloxacin, amikacin low resistance rate. The positive rates of ESBLs producing Klebsiella pneumoniae and Escherichia coli were 78.57% and 77.78% respectively. Gram-positive bacteria 1, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus positive. Four fungi, all yeasts, of which two were resistant to itraconazole. Conclusions Severe HAP in infants and young children is mainly caused by bacterial infection, mainly gram-negative bacteria, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and the positive rate of producing extended-spectrum β-lactamases . Of the common second and third generation cephalosporin resistance rate is high, the initial experience should use piperacillin / tazobactam and carbapenem antibiotics.