临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (7): 501-.doi: 10.3969/j.issn.1000-3606.2018.07.006

• 综合报道 • 上一篇    下一篇

儿童慢性化脓性肺疾病临床特征及细菌药敏分析#br#

田小银, 唐琳, 张祺煜, 李沁原, 张光莉, 谢晓虹, 罗健, 罗征秀   

  1. 重庆医科大学附属儿童医院呼吸科 儿童发育重大疾病国家国际科技合作基地 儿童发育疾病研究教 育部重点实验室 儿科学重庆市重点实验室(重庆 400014)
  • 收稿日期:2018-07-15 出版日期:2018-07-15 发布日期:2018-07-15
  • 通讯作者: 罗征秀 E-mail:luozhengxiu816@163.com
  • 基金资助:
    国家临床重点专科建设项目资助(No. 2011-873)

Clinical characteristics and antimicrobial susceptibility analysis of chronic suppurative lung disease in children 

TIAN Xiaoyin, TANG Lin, ZHANG Qiyu, LI Qinyuan, ZHANG Guangli, XIE Xiaohong, LUO Jian, LUO Zhengxiu   

  1. Respiratory Department of Children's Hospital of Chongqing Medical University, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014,  China
  • Received:2018-07-15 Online:2018-07-15 Published:2018-07-15

摘要:  目的 分析儿童慢性化脓性肺疾病的临床特点及细菌药敏结果。方法 回顾分析2013年1月—2016年12月 住院治疗的26例慢性化脓性肺疾病患儿的临床资料及支气管肺泡灌洗液(BALF)细菌培养药敏结果。结果 26例慢性化 脓性肺疾病患儿的平均年龄(18.3±18.4)月,咳嗽病程(11.1±9.5)周。25例(96.2%)肺部可闻及中/粗湿啰音,22例(84.6%) 肺部可闻及哮鸣音。17例(65.4%)临床拟诊迁延性肺炎,19例(73.1%)拟诊气道发育异常, 7例(26.9%)拟诊支气管哮喘。 支气管镜下均提示化脓性内膜炎,13例(50.0%)合并气道发育异常,BALF分类中性粒细胞显著升高。BALF中检出前三 位的细菌依次为肺炎链球菌7株、大肠埃希菌6株、流感嗜血杆菌5株。检出的肺炎链球菌对阿莫西林耐药率较低(28.6%), 对万古霉素、利奈唑胺、左氧氟沙星均敏感;检出的大肠埃希菌、流感嗜血杆菌对氨苄西林完全耐药,对哌拉西林耐药较 严重,对亚胺培南、美洛培南、哌拉西林他唑巴坦、阿米卡星敏感性较好。结论 儿童慢性化脓性肺疾病以婴幼儿多见,临 床易误诊为迁延性肺炎、气道发育异常、支气管哮喘、肺炎链球菌为最常见病原体,对阿莫西林耐药率较低;大肠埃希菌、 流感嗜血杆对抗生素的耐药问题严峻。

Abstract: Objective To explore the clinical characteristics and antimicrobial susceptibility of chronic suppurative lung disease in children. Method The clinical data and the bacterial culture results of bronchoalveolar lavage fluid (BALF) of 26 children with chronic suppurative lung disease (CSLD) from January 2013 to December 2016 were retrospectively analyzed. Results The average age of 26 children with CSLD was 18.3±18.4 months, and the duration of cough was 11.1±9.5 weeks. The middle/coarse wet rales can be heard in the lungs in 25 cases (96.2%), and wheezing rale in 22 cases (84.6%). Seventeen cases (65.4%) were clinically diagnosed of protracted pneumonia, 19 cases (73.1%) of airway dysplasia, and 7 cases (26.9%) of bronchial asthma. All the patients showed purulent endometritis under bronchoscopy, of whom 13 patients (50%) were complicated with airway dysplasia. Neutrophils were increased significantly in cell classification of BALF. The distribution of detected pathogens showed a predominance of Streptococcus pneumoniae (7 cases), followed by Escherichia coli (6 cases) and Haemophilus influenzae (5 cases). The rate of Streptococcus pneumoniae resistant to amoxicillin was relatively low (28.6%), and was sensitive to vancomycin, linezolid and levofloxacin. Escherichia coli and Haemophilus influenzae were completely resistant to ampicillin, and also had a serious resistance to piperacillin, while they were sensitive rather well to imipenem, meropenem, piperacillin tazobactam and amikacin. Conclusion CSLD is more common in infants and young children and is easy to be misdiagnosed as protracted pneumonia, airway dysplasia and asthma. Streptococcus pneumoniae is the most common pathogen which has a low resistant rate to amoxicillin. The antibiotic resistance of Escherichia coli and Haemophilus influenzae was serious.