李自强 刘小月 黄义双

[摘要]目的 研究我院儿童下呼吸道感染（LRI）的病原学特征。方法 选取2016年9月～2018年9月在我院诊断为LRI的435例患儿，采用Olympus BF-XP260系列（2.8 mm/4.0 mm）支气管镜检查及介入治疗，采用Bd PhoenixTM M50自动微生物鉴定和药敏分析系统对患儿肺泡灌洗液中分离培育的菌株进行鉴定和药敏检测。结果 435例患儿中共有113例细菌培养为阳性，阳性率为25.98%;113例細菌培养阳性患儿肺泡灌洗液标本共获得421株菌株，其中，革兰阴性菌株331株，占比78.62%，革兰阳性菌株90株，占比21.38%。革兰阴性病原菌普遍有较高的耐药性，其中对氨苄西林的耐药性为最高;革兰阳性病原菌中，金黄色葡萄球菌（MRSA）对万古霉素敏感性较高，对其他抗菌药物都有较高的耐药性;肺炎链球菌对红霉素有较高的耐药性，对其他抗菌药物较为敏感。耐甲氧西林MRSA、多重耐药铜绿假单胞菌（MDR-PA）、多重耐鲍曼不动杆菌（MDR-AB）和超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌（ESBLs）的检出率分别为52.46%、32.53%、34.72%、35.29%和32.26%。98例患儿经支气管镜介入治疗的有效率为100%（98/98）。结论 我院LRI患儿肺泡灌洗液细菌中革兰阴性菌相对较多，这些细菌有较高的耐药性，临床上肺部病灶经支气管镜下给予盐酸氨溴索注射液灌注可有效促进病灶的吸收，改善通气功能。

[关键词]下呼吸道感染;病原学特点;药敏分析;支气管镜

[中图分类号] R725.6          [文献标识码] A          [文章编号] 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