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目的调查儿童重症手足口病并发呼吸机相关性肺炎(VAP)病原菌的菌群分布及其耐药性状况,为临床合理使用抗菌药物提供依据。方法对2010年1～12月医院收治的儿童重症手足口病80例,取痰标本进行分离培养及鉴定,用K-B法检测42株病原菌对10种抗菌药的耐药性。结果分离出的42株病原菌,均为革兰阴性杆菌,前3位的是铜绿假单胞菌(30.1%)、非发酵革兰阴性杆菌(26.2%)、鲍曼不动杆菌(21.4%)。结论重症手足口合并VAP致病以革兰阴性杆菌为主,第三代头孢菌素、磺胺类可以作为临床治疗手足口并发VAP铜绿假单胞菌感染的首选药物;单环β-内酰胺类、青霉素类抗生素、第三代头孢菌素可以作为临床治疗手足口并发VAP鲍曼不动杆菌感染的首选药物。
Objective To investigate the flora distribution and drug resistance of pathogenic bacteria associated with ventilator-associated pneumonia (VAP) in children with severe HFMD and provide a basis for the rational use of antibacterials in clinic. Methods From January to December 2010, 80 children with severe hand-foot-mouth disease admitted to the hospital were enrolled, and sputum samples were isolated and identified. The resistance of 42 pathogens to 10 antibacterials was tested by K-B method. Results The 42 pathogens isolated were all Gram-negative bacilli. The top three were Pseudomonas aeruginosa (30.1%), non-fermentative gram-negative bacilli (26.2%), Acinetobacter baumannii (21.4%), . Conclusions Gram-negative bacilli are the main pathogens of severe hand-foot-mouth with VAP. The third-generation cephalosporins and sulfonamides are the first choice of clinical treatment of VAP-Pseudomonas aeruginosa in hand, foot and mouth. Monocyclic β-lactams , Penicillin antibiotics, third generation cephalosporins can be used as clinical treatment of hand, foot and mouth VAP Acinetobacter baumannii infection of choice for the drug.