高原地区儿童重症监护室呼吸机相关肺炎病原学分析

Pathogenic analysis of ventilator-associated pneumonia in the pediatric intensive care unit in high-altitude areas

摘要:

目的 探讨高原地区气候条件下儿童重症监护室（PICU）呼吸机相关肺炎（VAP）的病原学分布及耐药性，为防治VAP 提供临床依据。方法 对该院2011 年6 月至2013 年6 月PICU 中 94 例VAP 患儿的下呼吸道分泌物进行细菌培养和药敏试验。结果 94 例VAP 患儿中，单一细菌感染22 例（23%），72 例（77%）为混合感染，混合感染菌株中以肺炎克雷伯菌与鲍曼不动杆菌两种细菌最为常见（17 例，27%）。分离出178株病原菌，其中革兰阴性菌（G^- 菌）139 株（78%），以肺炎克雷伯菌、嗜麦芽窄食假单胞菌、鲍曼不动杆菌、铜绿假单胞菌为主。革兰阳性菌（G⁺ 菌）次之（26 株，15%），以金黄色葡萄球菌为主，真菌感染（13 株，7%）以白色念珠菌为主。大多数G^- 菌耐药性较高。铜绿假单胞菌广泛耐药，鲍曼不动杆菌仅对头孢哌铜／舒巴坦、亚胺培南高度敏感。G⁺ 菌存在多重耐药（耐甲氧西林），万古霉素对其有效。结论 高原地区VAP 的病原菌多为G^- 菌，具有混合感染和耐药性，这对合理选用抗菌药物、制定VAP 的重点防控措施具有指导意义。

Abstract:

Objective To investigate the pathogens of ventilator-associated pneumonia (VAP) and their drug resistance in the pediatric intensive care unit (PICU) in high-altitude areas and to provide a clinical basis for the prevention and treatment of VAP. Methods A total of 94 children with VAP hospitalized in the PICU in high-altitude areas between June 2011 and June 2013 were recruited. Their lower respiratory tract secretions were collected for bacterial culture and drug sensitivity test. Results Of the 94 children with VAP, 22 (23%) had a single bacterial infection, and 72 (77%) had mixed infections, mostly with Klebsiella pneumoniae and Acinetobacter baumannii (17 cases, 27%). Of the 178 isolated strains of pathogens, 139 (78%) were Gram-negative bacteria (G^- bacteria), mainly including Klebsiella pneumoniae, Stenotrophomonas maltophilia, Acinetobacter baumannii, and Pseudomonas aeruginosa, 26 (15%) were Gram-positive bacteria (G⁺ bacteria), mainly including Staphylococcus aureus, and 13 (7%) were fungi, mainly including Candida albicans. Most G^- bacteria had a high drug resistance. Pseudomonas aeruginosa was extensively drug-resistant. Acinetobacter baumannii was only highly sensitive to cefoperazone/sulbactam and imipenem. Multidrug resistance (methicillin resistance) was found in G⁺ bacteria, for which vancomycin was effective. Conclusions The pathogens of VAP in high-altitude areas are mostly G^- bacteria, which may cause mixed infections and develop drug resistance. This provides guidance for the rational use of antimicrobial drugs and the development of key prevention and control measures for VAP.