贵阳地区儿童重症社区获得性肺炎肺泡灌洗液病原及药敏分析

目的分析贵阳地区儿童重症社区获得性肺炎支气管肺泡灌洗液（BALF）病原学分布及耐药特点。方法收集989例重症社区获得性肺炎患儿临床资料，将支气管肺泡灌液采用支气管镜取出进行细菌培养、病毒以及肺炎支原体(MP)检测。结果（1）989例重症社区获得性肺炎患儿病原检出阳性716例，阳性率72.40%，细菌、病毒、支原体检出率分别33.27% （329例）、22.45%（222例）、31.45%（311例）。（2）细菌感染中的肺炎链球菌、金黄色葡萄球菌为最为常见的革兰阳性菌株(G+)；而肺炎克雷伯菌、大肠埃希菌为最为常见的革兰阴性菌株(G-)。培养菌株对青霉素类、红霉素、第1、2、3代头孢类抗生素有较高的耐药性，对头孢吡肟、拉氧头孢、哌拉西林、左氧氟沙星有较高的敏感性，对亚胺培南、万古霉素、利奈唑烷均无耐药发生。（3）病毒感染检出222例，其中呼吸道合胞病毒131例，腺病毒检测49例，流感病毒6例（A型2例，B型4例），副流感病毒36例（1型3例、2型4例、3型29例），病毒检出率以0～12月龄组最高，RSV、ADV感染主要集中在冬春季节。（4）肺炎支原体检出阳性率31.45%（311例），肺炎支原体检出率以3～5岁组最高。结论贵阳地区重症肺炎中肺炎克雷伯杆菌、肺炎链球菌、大肠埃希菌、金黄色葡萄球菌为重要的细菌病原。重要病毒为腺病毒和呼吸道病毒为主，1～12月龄组的病毒感染检出率比较高。

Pathogens and drug sensitivity of alveolar lavage fluid in children with severe community acquired pneumonia in Guiyang

ObjectiveTo analyze the pathogenic distribution and drug resistance of bronchoalveolar lavage fluid (BALF) in severe community acquired pneumonia children in Guiyang. Methods Clinical data of 989 children with severe community-acquired pneumonia admitted to Guiyang children′s hospital were collected from March 2015 to March 2016. Bronchoalveolar lavage fluid was removed by bronchoscopy for bacterial culture, virus and mycoplasma pneumoniae (MP) detection. ResultsAmong 989 children with severe community-acquired pneumonia, 716 cases were positive with pathogen detection, with a positive rate of 72.40%. The bacterial, viral and mycoplasma detection rates were 33.27% (329 cases), 22.45% (222 cases) and 31.45% (311 cases), respectively. Staphylococcus aureus and Streptococcus pneumoniae were the most common gram-positive strains in bacterial infection (G+); Escherichia coli and Klebsiella pneumoniae were the most common gram-negative strains (G-). The cultured strains showed high resistance to penicillin, erythromycin, and first-, second-, and third-generation cephalosporins; high sensitivity to cefepime, lactocefin, piperacillin, and furantoin; and no resistance to imipenem, vancomycin, and linezolidine. Virus were detected in 222 cases, including 131 cases of respiratory syncytial virus, 49 cases of adenovirus detection, 6 cases of influenza virus (2 cases of Type A and 4 cases of Type B), parainfluenza 36 cases (3 cases of Type 1, 4 cases of Type 2 and 29 cases of Type 3). Virus detection rate was the highest in children of 0-12 months age; and RSV, ADV mainly concentrated in the winter and spring season. The positive rate of mycoplasma pneumoniae in physical examination was 31.45% (311 cases), and the highest rate of mycoplasma pneumoniae was found in the 3-6 years old group. ConclusionKlebsiella pneumoniae, streptococcus pneumoniae, Escherichia coli and staphylococcus aureus are important bacterial pathogens in severe pneumonia in Guiyang. Adenovirus and respiratory virus were the most important viruses, and the detection rate of virus infection is higher in the group aged 1 to 12 months. Mycoplasma is the most important infectious agent of severe pneumonia in the 3-6 year group.