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目的探讨婴幼儿先天性心脏病术后下呼吸道感染常见病原菌及其耐药性,为临床正确选择抗菌药物提供依据。方法收集2012年1月-2014年2月先天性心脏病术后下呼吸道感染患儿痰标本分离出的112株病原菌,对病原菌进行药敏试验,细菌测定鉴定系统随机诊断试剂板分别为DL-96NE试剂板、DL-96STREP试剂板、DL-96FUNGUS试剂板等,测定系统为DL-96细菌测定系统。结果共分离出病原菌112株,其中革兰阴性菌76株占67.9%,革兰阳性菌23株占20.5%,真菌13株占11.6%;对铜绿假单胞菌较敏感的抗菌药物为亚胺培南、头孢哌酮/舒巴坦及阿米卡星,耐药率均<16.0%,对鲍氏不动杆菌较敏感的抗菌药物为多黏菌素B和阿米卡星,耐药率均<15.0%;对肺炎克雷伯菌敏感的抗菌药物为阿米卡星、四环素和美罗培南,耐药率均<19.0%;23株革兰阳性菌均对万古霉素保持较高的敏感率。结论婴幼儿先天性心脏病术后下呼吸道感染病原菌以革兰阴性菌为主,耐药率较高,应加强病原学及药敏检测,有针对性的应用抗菌药物。
Objective To investigate the common pathogens and drug resistance of lower respiratory tract infection after congenital heart disease in infants and young children and to provide evidence for the correct choice of antibiotics in clinic. Methods A total of 112 pathogenic bacteria isolated from children with sputum from patients with lower respiratory tract infection of congenital heart disease and from January 2012 to February 2014 were collected and drug susceptibility tests were performed on the pathogenic bacteria. The randomized diagnostic reagent plates of the bacterial identification system were DL- 96NE reagent plate, DL-96STREP reagent plate, DL-96FUNGUS reagent plate, and the determination system is DL-96 bacterial assay system. Results A total of 112 strains of pathogens were isolated, of which 76 strains were Gram-negative bacteria, 67.9% Gram-positive bacteria, 23 strains were Gram-positive bacteria, 20.5%, 13 strains were fungi, accounting for 11.6%. The antibacterial agents sensitive to Pseudomonas aeruginosa were imine Pei Nan, cefoperazone / sulbactam and amikacin, the drug resistance rate was <16.0%, more sensitive to A. baumannii antibacterial drugs polymyxin B and amikacin, drug resistance All <15.0%. The antibacterials sensitive to Klebsiella pneumoniae were amikacin, tetracycline and meropenem, the resistance rates were <19.0%, 23 strains of Gram-positive bacteria all maintained high sensitivity to vancomycin . Conclusions Gram-negative bacteria are the main pathogenic bacteria of lower respiratory tract infection in infants and children with congenital heart disease. The rate of drug resistance should be high. Etiological and drug susceptibility testing should be strengthened. Antibiotics should be used in a targeted manner.