Abstract: Objective To analyze the bacterial composition and clinical significance of sputum in children with severe pneumonia,in order to provide scientific evidence for clinical treatment. Methods A total of 1 136 children in Pediatric Intensive Care Unit of Children′s Hospital of Kaifeng were selected from May 2013 to January 2018.The drug resistance characteristics of the isolates were analyzed. Results A total of 921 pathogens were detected in 667 sputum specimens,mainly Gram-negative bacteria(708 strains). Bacterial distribution was not significantly different in different age groups.Klebsiella pneumoniae and Pseudomonas aeruginosa mainly existed in spring,summer and autumn.Staphylococcus aureus was mainly in winter.Klebsiella pneumoniae and Pseudomonas aeruginosa showed high resistance to AMK,GEN,CIP(87.86%,83.24%,81.50%) as well as CAZ,CPD and FOX(77.18%,77.18%,66.44%),respectively.And Staphylococcus aureus was primarily resistant to IPM,COT,FOX and ERY(82.68%,73.23%,70.08%,70.08%). Conclusion The pathogens in children with severe pneumonia are characterized by a clear seasonal distribution,and treatment should be based on past experience and drug resistance.

Key words: severe pneumonia, bacteria, sputum, children

摘要： 目的 分析重症肺炎儿童患者痰液中的细菌构成及其临床意义,为临床治疗提供科学依据。方法 选取2013年5月-2018年1月开封儿童医院PICU收治的1 136例重症肺炎患儿,对痰标本进行细菌学培养和分离,检测优势菌株及其耐药特性。结果 667份病原菌阳性样本中共检出921株病原菌,以革兰氏阴性菌为主(708株)。不同年龄分段的细菌分布影响不大。春、夏、秋主要以肺炎克雷伯菌和铜绿假单胞杆菌为主,冬季主要以金黄色葡萄球菌为主。肺炎克雷伯菌、铜绿假单胞杆菌分别对阿米卡里、庆大霉素、环丙沙里(87.86%,83.24%,81.50%)以及头孢他啶、头孢泊肟、头孢西丁(77.18%,77.18%,66.44%)表现出较高的耐药性。金黄色葡萄球菌主要耐受亚胺培南、甲氧苄吹朠胺甲哑唑、利红霉素和头孢西丁(82.68%,73.23%,70.08%,70.08%)。结论 重症肺炎儿童的病原菌构成存在明显的季节分布特点,应结合过往经验和耐药情况进行治疗。

关键词: 重症肺炎, 细菌, 痰液, 儿童