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。
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.