探讨麻疹继发细菌性肺炎的病原菌构成及药敏试验结果。

采用回顾性研究法，对2007年4月至2008年12月，在本院确诊的105例麻疹继发细菌性肺炎患儿下呼吸道合格痰标本，进行细菌培养并分析。根据药敏试验前的临床用药及疗效，结合痰培养结果，将其分为药敏组(n＝80)和耐药组(n＝25)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准)。

①感染类型：革兰阴性菌感染为92例(87.60%)，其中前3位为大肠埃希菌、肺炎克雷伯菌、副流感嗜血杆菌。革兰阳性菌感染为8例(7.62%)，其中肺炎链球菌为6例，金黄色葡萄球菌及溶血性链球菌各为1例。真菌感染为5例(4.76%)。②药敏试验结果：对革兰阴性菌，亚胺培南敏感率为100.00%。氨基糖苷类、喹诺酮类及氧哌嗪/舒巴坦钠亦有较高药敏率。对革兰阳性菌，利福平药敏率为100.00%，万古霉素、氧氟沙星为87.50%。对真菌，氟康唑、两性霉素B药敏率为100.00%。③疗效及转归：药敏组治疗无效为19例，根据药敏试验结果调整治疗方案后，其中17例(89.40%)治愈，2例未愈。耐药组治疗无效为25例，根据药敏试验结果调整治疗方案3 d后，其中21例(84.00%)病情恢复，2例并发气胸死亡，2例未愈出院。

麻疹继发细菌性肺炎的病原菌多为条件致病菌，部分与院内感染有关，故早诊断、早隔离、早明确病原菌及根据药敏试验结果合理选择抗菌药物，可降低细菌耐药性。

To investigate the results of etiology and condition of susceptibility test of bacterial pneumonia caused by measles in order to provide basis for clinical diagnosis and treatment.

From April 2007 to December 2008, qualified sputum specimens of lower respiratory tract from 105 children diagnosed as bacterial pneumonia caused by measles were carried on a germ development analyzed by bacterial culture. According to the clinical medication, curative effects and results of sputum culture, 105 specimens were divided into drug sensitivity group (n=80) and drug resistance group (n=25). Informed consent was obtained from all participates.

① Infection types: The infection of Gram-negative bacteria was 92 cases(87.60%), among them, the first three are escherichia coli, Klebsiella pneumonia, and haemophilus parainfluenzae. The infection of Gram-positive bacteria was 8 cases(7.62%), including 6 cases of streptococcus pneumoniae, 1 case of staphylococcus aureus, and 1 case of hemolytic streptococcus. And the fungous infection was 5 cases(4.76%). ②Results of susceptibility test: The drug sensitive rates of Gram-negative bacteria and imipenem were 100.00%, respectively. Aminoglycosides, quinolones and sulbactam also had high drug sensitive rates. The drug sensitive rates of rifampicin (RFP) to Gram-positive bacteria was 100.00%, to vancomycin and ofloxacin were 87.50%, respectively. As for fungi, the drug sensitive rates of fluconazol and amphotericin were 100.00%. ③ Curative effects and prognosis: The ineffective treatment of drug sensitivity group was 19 cases, but after adjusting the therapeutic regimen according to the results of drug sensitive test, 17 cases (89.40%) cured and 2 had no more improvement. The ineffective treatment of drug resistance group was 25 cases, among them, 21 cases (84.00%) recovered after adjusting the therapeutic regimen according to the results of drug sensitive test for 3 days, 2 died of pneumothorax, and 2 discharged without recovery.

The main pathogenic bacteria of bacterial pneumonia caused by measles is conditional pathogenic bacteria, and hospital onset of infection is another reason, so early detection, diagnosis, and treatment could decrease the bacterial resistance.