Bacteriology and Clinical Analysis of Severe Pneumonia in Infants and Young Children in Pediatric Intensive Care Unit

Objective To explore the value of sputum bacterial culture in treatment of severe pneumonia in infants and young children.Methods Two hundred and seventy infants and young children with severe pneumonia of pediatric intensive care unit(PICU) were collected.Lower respiratory tract sputum was sucked by disposable sterile suction tube in underpressure,and eligible sputum samples were detected by bacterial culture and sensitivity analysis.Results One hundred and sixty-seven bacterial strains were obtained from sputum culture,with a positive rate of 61.85%,Gram-positive cocci in 81 strains(48.50%),Gram-negative bacilli in 79 strains(47.31%),fungi in 7 strains(4.19%);Suppurative Streptococcus and Klebsiella pneumoniae were primary pathogens,in 41 strains(24.55%) and 39 strains(23.35%),respectively.Escherichia coli was the next one,in 24 strains(14.37%);Gram-positive cocci had a high resis-tance rate for penicillin,erythromycin and clindamycin,but the resistance rate for vancomycin and rifampicin was low;Gram-negative bacilli had a high resistance rate for Ampicllin sulbactam and Cefalotin,but the resistance rate for imipenem,ciprofloxacin was low.Compared to negative groups,positive sputum culture group had no significant difference in age-sex distribution,organ dysfunction,and account of WBC and leukocytotic cases(Pa0.05);Compared to Gram-negative bacilli group of sputum culture,Gram-positive cocci group had significant diffe-rence in the incidence of gastrointestinal dysfunction and microcirculatory disorders(Pa0.05);Antibiotics used at admission were divided into 3 groups including sensitive,non-detected,resistive groups according to the results of sputum culture.Comparing in three groups,there were significant difference in the effect of treatment(Pa0.01).Antibiotics of patients with poor effect were adjusted by the results of sputum culture,then 82.6% of patients improved after 3 days.Conclusions Imipenem can be the preferred antibiotics for those patients with serious lung infection,especially those already receives third-generation cephalosporins but without effect,if necessary,we can select vancomycin;Gram-negative bacilli maybe the pathogen of infection when patients are complicated with gastrointestinal dysfunction and microcirculatory di-sorders.It is difficult to distinguish bacterial infections from non-bacterial infections for severe pneumonia only by clinical symptoms,leukocyte count,X-ray characteristics etc;High detection rate of sputum bacterial culture can clew the pathogen of lung infection in a certain extent.And sputum bacterial culture is an important technique to detect the pathogens of bacteroidal pneumonia.