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目的探讨儿科重症监护病房先天性心脏病术后呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)铜绿假单胞菌(Pseudomonas aeruginosa,PA)感染患者的临床特点及细菌耐药性,为抗菌素合理应用提供指导。方法总结广东省人民医院儿科重症监护病房(PICU)2010年1月至2014年12月先天性心脏病术后确诊PA-VAP患儿的临床资料及药敏结果。结果 2010年1月至2014年12月先天性心脏病手术患儿共1 396例,PA-VAP患儿25例,分离率1.79%。2010年3例(12%),2011年4例(16%),2012年4例(16%),2013年7(28%),2014年7例(28%)。发生率分别为0.92%(3/327),2.02%(4/198),1.43%(4/280),2.59%(7/270),2.18%(7/321)。年龄2~10个月,平均年龄(4.36±2.24)个月,2~3个月10例(40%);4~6个月11例(44%),7~10个月4例(16%),其中年龄7个月以下21例(84%)。敏感抗生素依次为丁胺卡那霉素(96%),妥布霉素(96%),庆大霉素(92%),哌拉西林/他唑巴坦(88%),头孢他啶(88%),头孢吡肟(88%)。3株(12%)耐亚胺培南,22株(88%)对亚胺培南敏感。耐药率为100%的抗生素为氨苄西林/舒巴坦、头孢替坦、头孢唑啉、头孢曲松、复方新诺明。结论先天性心脏病术后PA感染率呈逐年升高趋势,7个月以下婴儿感染率明显升高;抗菌治疗依病情可首选哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢吡肟、亚胺培南,重症可联用氨基糖甙类。
Objective To investigate the clinical features and bacterial resistance of patients with infection of Pneumomonas aeruginosa (PA) after ventilator-associated pneumonia (VAP) in pediatric intensive care unit with congenital heart disease. Application guidance. Methods The clinical data and drug susceptibility of patients with PA-VAP diagnosed in the Department of Pediatric Intensive Care Unit (PICU) from January 2010 to December 2014 in Guangdong Provincial People’s Hospital were summarized. Results From January 2010 to December 2014, there were 1 396 children with congenital heart disease and 25 children with PA-VAP. The isolation rate was 1.79%. 3 (12%) in 2010, 4 (16%) in 2011, 4 (16%) in 2012, 7 (28%) in 2013 and 7 (28%) in 2014. The incidence rates were 0.92% (3/327), 2.02% (4/198), 1.43% (4/280), 2.59% (7/270) and 2.18% (7/321), respectively. The average age was 4.36 ± 2.24 months, 10 cases (40%) in 2 to 3 months, 11 cases (44%) in 4 to 6 months, 4 cases (7 to 10 months) in 4 to 6 months %), Of which 21 cases (84%) were younger than 7 months. Sensitive antibiotics followed by amikacin (96%), tobramycin (96%), gentamicin (92%), piperacillin / tazobactam (88%), ceftazidime (88% ), Cefepime (88%). Three strains (12%) were resistant to imipenem and 22 strains (88%) were sensitive to imipenem. Antibiotics with a resistance rate of 100% were ampicillin / sulbactam, cefotetan, cefazolin, ceftriaxone, and cotrimoxazole. Conclusion The infection rate of PA after congenital heart disease is increasing year by year, and the infection rate of infants under 7 months is obviously increased. According to the condition of antibacterial therapy, piperacillin / tazobactam, cefoperazone / sulbactam, Cefepime, imipenem, severe aminoglycosides can be used together.