Abstract：Objective: To investigate the pathogenic microorganisms and drug resistance in children with acute attack of bronchial asthma complicated with hospital acquired pneumonia (HAP), and to analyze its risk factors. Methods: The clinical data of 609 cases of acute attack of bronchial asthma in children were retrospectively analyzed in our hospital from January 2016 to December 2018, and they were divided into HAP group and non-HAP group according to whether HAP occurred or not. The pathogenic microorganisms detection and drug susceptibility test were carried out of the HAP group, and the distribution characteristics and drug resistance were analyzed according to the test results, also the risk factors of of HAP in children with acute attack of bronchial asthma were analyzed by single factor analysis and multiple factor Logistic regression analysis method. Results: There were 30 cases with HAP among 609 children with acute attack of bronchial asthma, and the incidence rate of HAP was 4.93% (30/609). A total of 39 pathogens were detected in the HAP group, including 32 Gram-negative bacteria (82.50%), 4 Gram-positive bacteria (10.26%), 1 fungus (2.56%), 1 Mycoplasma (2.56%) and 1 Chlamydia (2.56%), and there was no virus or tuberculosis infection. The main Gram-negative bacteria in HAP pathogenic bacteria were highly resistant to ampicillin cefazolin and ceftriaxone (>35.00%), but the resistance rates to piperacillin-tazobactam, amikacin and imipenem were low (<15.00%). The main Gram-positive bacteria in HAP pathogenic bacteria showed high resistance to penicillin, oxacillin, erythromycin and clindamycin (>45.00%), but low resistance to gentamicin, vancomycin, levofloxacin, compound sulfamethoxazole, ciprofloxacin and rifampicin (<10.00%). Logistic regression analysis showed that invasive operation of respiratory system, preventive using of antibiotics, glucocorticoid using time >14d and hospitalization time >7d were independent risk factors for HAP in children with acute attack of bronchial asthma (OR = 3.655, 2.740, 2.596, 2.542, P < 0.05). Conclusion: Gram-negative bacteria are the main pathogens of HAP in children with acute attack of bronchial asthma, following by Gram-positive bacteria, and the main Gram-negative bacteria are lowly resistant to piperacillin-tazobactam, amikacin and imipenem, and the main Gram-positive bacteria are lowly resistant to gentamicin, vancomycin, levofloxacin, compound sulfamethoxazole, ciprofloxacin and rifampicin, in addition, invasive operation of respiratory system, preventive using of antibiotics, glucocorticoid using time and hospital stay too long can increase the risk of HAP, and it is necessary to use antibiotics reasonably in clinical work and take active intervention measures to reduce the occurrence of HAP.
张传玲, 方代华, 田礼军. 支气管哮喘急性发作患儿并HAP的致病微生物耐药性及因素分析[J]. 河北医学, 2020, 26(1): 109-113.
ZHANG Chuanling, FANG Daihua, TIAN lijun. Analysis of Pathogenic Microorganism, Drug Resistance and Factors in Children with Acute Attack of Bronchial Asthma Complicated with HAP. HeBei Med, 2020, 26(1): 109-113.
[1] Pound CM,McDonald J,Tang K,et al.Dexamethasone versus prednisone for children receiving asthma treatment in the paediatric inpatient population: protocol for a feasibility randomised controlled trial[J].BMJ Open,2018,8(12):e025630. [2] Munro S,Haile-Mariam A,Greenwell C,et al.Implementation and dissemination of a department of veterans affairs oral care initiative to prevent hospital-acquired pneumonia among nonventilated patients[J].Nurs Adm Q,2018,42(4):363~372. [3] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2003,81(7):460~465. [4] 刘常青,左满凤,钟新,等.脑性瘫痪儿童医院获得性肺炎的病原菌分布及耐药性分析[J].临床肺科杂志,2016,21(3):443~446. [5] 张艺,帅向华,余道军.小儿医院获得性肺炎的病原菌及危险因素分析[J].中华全科医学,2014,29(3):1212~1214. [6] Blanchard AC,Rooney AM,Yau Y,et al.Early detection using qPCR of pseudomonas aeruginosa infection in children with cystic fibrosis undergoing eradication treatment[J].Cyst Fibros,2018,17(6):723~728. [7] Bernatz JT,Safdar N,Hetzel S,et al.Antibiotic overuse is a major risk factor for clostridium difficile infection in surgical patients[J].Infect Control Hosp Epidemiol,2017,38(10):1254~1257.
2020, Vol. 26 
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