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目的探讨儿童重症监护病房(PICU)机械通气患儿呼吸机相关性肺炎(VAP)的病原菌群,并对细菌耐药性进行分析,为抗生素的使用提供依据。方法对2012年6月至2015年5月我院PICU中发生的34例VAP患儿的下呼吸道分泌物细菌培养结果进行回顾性分析。结果共计检出病原菌40株,其中革兰阴性菌34株(85.0%),革兰阳性菌4株(10.0%),真菌2株(5.0%)。前四位致病菌依次为:鲍曼不动杆菌(25.0%)、肺炎克雷伯菌(20.0%)、铜绿假单胞菌(15.0%)、大肠埃希菌(12.5%),均对儿科常用抗生素耐药性严重。鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率较低,肺炎克雷伯菌、大肠埃希菌对亚胺培南、哌拉西林/他唑巴坦的耐药率较低,铜绿假单胞菌则对喹诺酮类耐药率较低。结论应加强机械通气儿童患者呼吸道管理及病原学监测,合理应用抗生素。
Objective To investigate the pathogens flora of ventilator-associated pneumonia (VAP) in children with mechanical ventilation in children with intensive care unit (PICU) and to analyze the drug resistance of bacteria in patients with mechanical ventilation and provide a basis for the use of antibiotics. Methods A retrospective analysis was performed on the bacterial culture of lower respiratory tract secretions in 34 children with VAP occurring in our PICU from June 2012 to May 2015. Results A total of 40 pathogenic bacteria were detected, of which 34 (85.0%) were Gram-negative bacteria, 4 (10.0%) were Gram-positive bacteria and 2 (5.0%) were fungi. The top four pathogenic bacteria were Acinetobacter baumannii (25.0%), Klebsiella pneumoniae (20.0%), Pseudomonas aeruginosa (15.0%) and Escherichia coli (12.5%), Pediatric commonly used antibiotic resistance is serious. Acinetobacter baumannii cefoperazone / sulbactam resistance rate is low, Klebsiella pneumoniae, Escherichia coli on imipenem, piperacillin / tazobactam resistance rate is low, Pseudomonas aeruginosa quinolones resistance rate is low. Conclusion Respiratory management and etiological monitoring of children with mechanical ventilation should be strengthened and antibiotics should be rationally applied.