【摘要】 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。更多还原

【Abstract】 Objectives To investigate the clinical characteristics and drug sensitivity of Pseudomonas aeruginosa(PA)infection in children with ventilator-associated pneumonia(VAP) after surgery of congenital heart disease in the pediatric intensive care unit(PICU), and to provide guidiance for reasonable use of antibiotics. Methods A total of25 patients with VAP caused by PA in PICU of Guangdong General Hospital from January 2010 to December 2014 were investigated retrospectively. The drug resistance profile of PA was analyzed. Results There were 1 396 critically ill children received surgery of congenital heart disease transferred to PICU from January 2010 to December 2014. Of these patients, there were 25 infected with PA-VAP, the isolation rate was 1.79%(25 / 1396) : 3 cases(12%) in 2010; 4cases(16%) in 2011; 4 cases(16%) in 2012; 7 cases(28%) in 2013 and 7 cases(28%) in 2014. The incidences of PA were 0.92%(3 / 327), 2.02%(4 / 198), 1.43%(4 / 280), 2.59%(7 / 270) and 2.18%(7 / 321). Ages ranged2-10 months, the average age was(4.36 ± 2.24) months : 2-3 months in 10 cases(40%); 4-6 months in 11 cases(44%); 7-10 months in 4 cases(16%) and <7 months in 21 cases(84%). Antibiotic susceptibility test showed that amikaxin was the most susceptible antibiotic(96%), followed by tobramycin(96%), gentamicin(92%), piperacillin-tazobactam(88%), cefepime(88%) and ceftazidime(88%). The drug resistance rate of PA was 100% for ampicillin /sulbactam, cefotetan, cefazolin, ceftriaxone and sulfamethoxazole. There were 3 imipenem-resistant PA strains(12%)and 22 imipenem-susceptible strains(88%). Conclusions The infection rate of PA in PICU after surgery of congenital heart disease is increasing. Patients aged less than 7 months are prone to PA infection, and most of them are suffering from severe underlying diseases..We should pay more attention to the occurrence of nosocomial infection. Piperacillin-tazobactam, cefoperazone / sulbactam, cefepime, ceftazidime and imipenem are the best options for PA-VAP treatment,or combining with aminoglycosides for critically ill patients.更多还原