我院兒童下呼吸道感染病原學特點

李自強 劉小月 黃義雙

[摘要]目的 研究我院兒童下呼吸道感染（LRI）的病原學特征。方法 選取2016年9月～2018年9月在我院診斷為LRI的435例患兒，采用Olympus BF-XP260系列（2.8 mm/4.0 mm）支氣管鏡檢查及介入治療，采用Bd PhoenixTM M50自動微生物鑒定和藥敏分析系統對患兒肺泡灌洗液中分離培育的菌株進行鑒定和藥敏檢測。結果 435例患兒中共有113例細菌培養為陽性，陽性率為25.98%;113例細菌培養陽性患兒肺泡灌洗液標本共獲得421株菌株，其中，革蘭陰性菌株331株，占比78.62%，革蘭陽性菌株90株，占比21.38%。革蘭陰性病原菌普遍有較高的耐藥性，其中對氨芐西林的耐藥性為最高;革蘭陽性病原菌中，金黃色葡萄球菌（MRSA）對萬古霉素敏感性較高，對其他抗菌藥物都有較高的耐藥性;肺炎鏈球菌對紅霉素有較高的耐藥性，對其他抗菌藥物較為敏感。耐甲氧西林MRSA、多重耐藥銅綠假單胞菌（MDR-PA）、多重耐鮑曼不動桿菌（MDR-AB）和超廣譜β-內酰胺酶肺炎克雷伯菌和大腸埃希菌（ESBLs）的檢出率分別為52.46%、32.53%、34.72%、35.29%和32.26%。98例患兒經支氣管鏡介入治療的有效率為100%（98/98）。結論 我院LRI患兒肺泡灌洗液細菌中革蘭陰性菌相對較多，這些細菌有較高的耐藥性，臨床上肺部病灶經支氣管鏡下給予鹽酸氨溴索注射液灌注可有效促進病灶的吸收，改善通氣功能。

[關鍵詞]下呼吸道感染;病原學特點;藥敏分析;支氣管鏡

[中圖分類號] R725.6? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-4721（2019）6（b）-0186-04

[Abstract] Objective To study the etiological characteristics of children with lower respiratory infection （LRI） in our hospital. Methods A total of 435 children with clinical diagnosis of LRI from September 2016 to September 2018 were selected in our study. Childrens were examined and treated with Olympus BF-XP260 bronchoscopy （2.8 mm/4.0 mm）. Bacteria in the sputum were separated， identified and tested by Bd PhoenixTM M50 automatic microbial identification and drug sensitivity analysis system. Results At least one pathogen was detected in 113 out of 435 patients and the overall positive rate was 25.98%. A total of 421 strains were obtained， among which 331 strains were gram-negative strains （78.62%）， 90 strains were gram-positive strains （21.38%）. Gram-negative pathogens were insensitive to most antibiotics， especially to ampicillin. Among gram-positive pathogens， Staphylococcus aureus （MRSA） was sensitive to vancomycin and insensitive to other antibiotics; Streptococcus pneumoniae was insensitive to erythromycin and sensitive to other antibiotics. The detection rates of MRSA， multi-drug resistant pseudomonas （MDR-PA）， multidrug-resistant acinetobacter baamannii （MDR-AB）， extended-spectrum lactamasa klebsiella peeumoniac （ESBLs） （Klebsiella pneumoniae and Escherichia coli） were 52.46%， 32.53%， 34.72%，35.29% and 32.26% respectively. The effective rate of subbronchial therapy was 100% （98/98）. Conclusion Gram-negative bacteria is more common during these two years in our hospital. Bacterias were insensitive to most antibiotics. It is effective to treat children with LRI by clinical infusion of Ambroxol Hydrochloride under bronchoscope.

[Key words] Lower respiratory infection; Etiological characteristics; Drug sensitivity analysis; Bronchoscope