中国实用儿科杂志

中国实用儿科杂志

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下呼吸道细菌感染与婴幼儿持续喘息关系及抗生素疗效分析

  

  1. 重庆医科大学附属儿童医院 a呼吸内科；b 泌尿外科，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   400016
  • 出版日期:2016-12-06 发布日期:2016-12-09

Association between persistent wheezing and bacterial infection of the lower respiratory tract in infants and young children and analysis of the curative effect of antibiotics

  1. Respiratory Medicine，Children’s Hospital of  Chongqing Medical University，Chongqing  400016，China
  • Online:2016-12-06 Published:2016-12-09

摘要：

目的　分析下呼吸道细菌感染与婴幼儿持续喘息的关系及抗生素的疗效。方法    收集重庆医科大学附属儿童医院2005年1月1日到2016年1月1日因持续喘息住院的598例婴幼儿的临床资料， 分析其支气管肺泡灌洗液（BALF）中细菌培养、鼻咽部抽吸物呼吸道7种病毒、 肺炎支原体及衣原体检测结果。进一步根据支气管肺泡灌洗液细菌培养阳性的婴幼儿院内使用抗生素情况分为抗生素组41例， 未使用抗生素组26例， 对两组患儿症状、 体征改善总有效率及平均住院天数进行评分。结果　（1）136例行纤维支气管镜灌洗的婴幼儿中， 有67例（49.3%）患儿支气管肺泡灌洗液细菌培养阳性， 其中， 检出率最高的3种细菌分别为肺炎链球菌、 肺炎克雷伯菌肺炎亚种和副流感嗜血杆菌； （2）出院时抗生素组较对照组患儿症状改善总有效率有明显增加（P＜0.05）， 且平均住院天数较对照组缩短（P＜0.05）； （3）肺炎链球菌耐药率最高的3种抗生素分别为： 美洛配能（81.82%）、红霉素（63.64%）及头孢西丁（54.55%）。结论    细菌感染与部分婴幼儿持续性喘息有关， 在运用抗生素治疗后症状、 体征改善总有效率有明显增加， 平均住院天数较未用抗生素组缩短（P＜0.05）。因此， 抗生素治疗对部分持续喘息的婴幼儿可能有效。

关键词: 持续喘息, 婴幼儿, 细菌, 抗生素

Abstract:

Objective　To investigate the relevance of bacteria infection of the lower respiratory tract with persistent wheezing of infants and young children，and further evaluate the effect of antibiotic therapy on them. Methods　We collected the medical records of the infants and young children hospitalized for persistent wheezing in Children’s Hospital of Chongqing Medical University from January 1， 2005 to January 1， 2016， and analyzed the pathogen in BALF culture，including bacteria culture， the seven kinds of viral antigen of nasopharyngeal aspirate， MP-PCR and CP-PCR. Further，we divided the cases with positive bacterial isolates into two groups based on whether they were administered with antibiotics. The population proportion of symptom improvement and the mean days of hospital stay were recorded. Results　Among the 136 children who underwent BALF，there were 67（49.3%） children with positive bacterial isolates，and the most common bacteria were Pneumococcal pneumonia，Klebsiella pneumoniae pneumonia subspecies，and Haemophilus parainfluenzae. The population proportion of symptom improvement of antibiotic group was higher than control group（P＜0.05），and the mean days of hospitalization was shorter in antibiotic group compared with control group （P＜0.05）. For Streptococcus pneumoniae，a high prevalence of resistant strains was found to Meropenem（81.82%），Macrolide erythrocin（63.64%） and Cefoxitin resistence（54.55%）. Conclusion    Bacterial infection of the lower respiratory tract maybe relevant in some infants and young children with persistent wheezing，and antibiotic treatment may improve the rate of  symptom improvement in these children and shorten the mean days of hospitalization. Therefore，some of infants and young children with persistent wheezing can be improved after antibiotic treatment.

Key words: persistent wheezing, infants and young child, bacteria, antibiotics