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目的调查儿童医院院内获得性肺炎(HAP)的病原菌构成,并分析HAP的危险因素。方法采集深部痰,进行革兰氏染色、细菌培养及药敏测定,并对HAP患儿危险因素进行非条件多因素Logistic回归分析。结果56例HAP患儿以革兰氏阴性菌(90.4%)感染居多,前4位分别是铜绿假单胞菌25%(14/56)、肺炎克雷伯菌21.4%(12/56)、大肠埃希氏菌14.3%(8/56)、鲍曼不动杆菌10.7%(6/56)。Logistic回归分析显示,HAP与住院时间大于7 d(P<0.01)、侵入性操作(P<0.01)、三代头孢菌素应用(P<0.05)相关。结论小儿HAP病原菌以革兰氏阴性菌多见,住院时间长、侵入性操作、三代头孢菌素应用是小儿HAP的独立危险因素。
Objective To investigate the pathogens of hospital acquired pneumonia (HAP) in Children’s Hospital and to analyze the risk factors of HAP. Methods Deep phlegm was collected for Gram stain, bacterial culture and drug susceptibility testing. Logistic regression analysis was conducted on risk factors of HAP in children. Results The majority of HAP children were infected with Gram-negative bacteria (90.4%) in 56 cases. The top 4 were 25% (14/56) of Pseudomonas aeruginosa, 21.4% (12/56) of Klebsiella pneumoniae, Escherichia coli 14.3% (8/56), Acinetobacter baumannii 10.7% (6/56). Logistic regression analysis showed that HAP was associated with more than 7 days of hospital stay (P <0.01), invasive procedures (P <0.01) and third-generation cephalosporins (P <0.05). Conclusions The pathogenic bacteria of HAP in children are more common with Gram-negative bacteria, long hospital stay, invasive operation and the third generation cephalosporins are independent risk factors for HAP in children.