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目的调查儿童先天性心脏病术前患儿肺部感染病原菌的分布特点及耐药现状,为临床用药提供依据。方法对2006年12月至2008年3月第三军医大学新桥医院PICU收治的338例先天性心脏病术前肺部感染患儿吸取下呼吸道痰液,进行细菌培养和药敏分析。结果检出致病菌179株,阳性率为52.95%。以肺炎链球菌菌最为多见(23.46%)。药敏显示革兰阳性球菌对青霉素类、头孢类、红霉素类耐药率较高;革兰阴性杆菌对大部分青霉素类、大部分头孢类耐药率较高。结论先天性心脏病术前患儿肺部感染病原菌以G+球菌与G-杆菌大致相等,细菌耐药日趋严重,根据体外药敏结果合理选用抗生素十分必要。对严重肺部感染,选用三代头孢治疗无效、原发病较为严重者,可首选亚胺培南抗菌治疗。
Objective To investigate the distribution characteristics and drug resistance of pulmonary pathogens in preoperative children with congenital heart disease and provide basis for clinical use. Methods From December 2006 to March 2008, 338 children with prenatal pulmonary infection undergoing PICU in Xinqiao Hospital of Third Military Medical University were enrolled in the study. Bacterial culture and drug susceptibility analysis were performed on sputum from lower respiratory tract. Results 179 pathogens were detected, the positive rate was 52.95%. Streptococcus pneumoniae bacteria most common (23.46%). Susceptibility showed that Gram-positive cocci penicillins, cephalosporins, erythromycin higher resistance rate; Gram-negative bacilli most penicillins, most of the high rate of cephalosporins. Conclusions The pathogenic bacteria of pulmonary infection in children with congenital heart disease are almost equal to those of G-bacteria and the bacterial resistance is becoming more and more serious. It is necessary to select antibiotics reasonably according to the results of drug sensitivity in vitro. Severe pulmonary infection, the choice of third-generation cephalosporin treatment ineffective, the more serious primary disease, the preferred antimicrobial imipenem treatment.