2025年4月8日 星期二
首页        期刊介绍        编委会        投稿指南        期刊订阅        广告合作        联系我们        English
河北医学  2020, Vol. 26 Issue (1): 109-113    DOI: 10.3969/j.issn.1006-6233.2020.01.026
  临床研究 本期目录 | 过刊浏览 | 高级检索 |
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
张传玲, 方代华, 田礼军
江苏省徐州市儿童医院检验科, 江苏 徐州 221000
Analysis of Pathogenic Microorganism, Drug Resistance and Factors in Children with Acute Attack of Bronchial Asthma Complicated with HAP
ZHANG Chuanling, FANG Daihua, TIAN lijun
XuZhou Children's Hospital, Jiangsu Xuzhou 221000, China
全文: PDF (1214 KB)   HTML (1 KB) 
输出: BibTeX | EndNote (RIS)      
摘要 目的:探讨支气管哮喘急性发作患儿并医院获得性肺炎(HAP)的致病微生物及耐药性,并分析其危险因素。方法:回顾性分析2016年1月至2018年12月本院收治的609例小儿支气管哮喘急性发作的临床病例资料,根据是否发生HAP而将其分为HAP组与非HAP组。HAP组均进行致病微生物检测及药敏测定,根据检测结果分析其分布特点及耐药性,另采用单因素及及多因素Logistic回归分析法分析可能影响支气管哮喘急性发作患儿并HAP的危险因素。结果:609例小儿支气管哮喘急性发作中共有30例发生HAP,HAP发生率为4.93%(30/609);HAP组患儿共检测出39株病原体,其中革兰阴性菌32株(82.05%),革兰阳性菌4株(10.26%),真菌1株(2.56%)、支原体1株(2.56%)、衣原体1株(2.56%),未见病毒及结核感染;HAP致病菌中的主要革兰阴性菌均对氨苄西林、头孢唑啉及头孢曲松有较高的耐药性(>35.00%),但均对哌拉西林-他唑巴坦、阿米卡星及亚胺培南耐药率低(<15.00%);HAP致病菌中的主要革兰阳性菌对青霉素、苯唑西林、红霉素、克林霉素均有较高的耐药性(>45.00%),但对庆大霉素、万古霉素、左旋氧氟沙星、复方新诺明、环丙沙星及利福平耐药性较低(<10.00%);经Logistic回归分析法分析,呼吸系统侵入性操作、预防性使用抗菌药物、糖皮质激素使用时间>14d及住院时间>7d均是小儿支气管哮喘急性发作并HAP的独立危险因素(OR=3.655、2.740、2.596、2.542,P<0.05)。结论:支气管哮喘急性发作患儿并HAP病原菌以革兰阴性菌为主,其次为革兰阳性菌,且主要革兰阴性菌均对哌拉西林-他唑巴坦、阿米卡星及亚胺培南耐药率低,主要革兰阳性菌均对庆大霉素、万古霉素、左旋氧氟沙星、复方新诺明、环丙沙星及利福平耐药率低,另呼吸系统侵入性操作、预防性使用抗菌药物、糖皮质激素使用时间及住院时间过长均可增加HAP发生风险,临床工作中需合理应用抗生素,并积极采取干预对策,以减少HAP的发生。
服务
把本文推荐给朋友
加入我的书架
加入引用管理器
E-mail Alert
RSS
作者相关文章
张传玲
方代华
田礼军
关键词 支气管哮喘急性发作期医院获得性肺炎病原菌耐药性    
AbstractObjective: 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.
Key wordsBronchial asthma    Acute episode    Hospital-acquired pneumonia    Pathogens    Drug resistance
    
基金资助:江苏省徐州市科研计划项目,(编号:XZZD1368)
引用本文:   
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.
链接本文:  
http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.01.026     或     http://www.hbyxzzs.cn/CN/Y2020/V26/I1/109
冀ICP备2025106803号    冀公网安备13080202000786号
版权所有 © 2016 《河北医学》杂志社
本系统由北京玛格泰克科技发展有限公司设计开发