探讨儿科重症监护病房(PICU)医院获得性鲍曼不动杆菌肺炎(ABHAP)的发病情况、危险因素及耐药特点，探讨其预防和治疗措施。

选择2013年9月至2014年9月于四川大学华西第二医院PICU发生医院获得性肺炎(HAP)的91例患儿的临床病历资料为研究对象。根据患儿是否为ABHAP，将其分为研究组(n＝19)与对照组(n＝72)。采用回顾性分析方法分析所有患儿的年龄、性别、基础疾病、合并症、免疫功能、危重评分、发生HAP前于PICU住院时间、留置胃管情况、有创机械通气时间、抗菌药物使用情况、合并其他病原菌感染情况、药物敏感试验结果及治疗转归等。对HAP患儿病原菌分布情况，以及ABHAP发病情况、耐药特点及其相关危险因素进行统计学分析。两组患儿年龄、性别构成比、危重评分、基础疾病及合并症等基本临床资料比较，差异均无统计学意义(P>0.05)。

①本研究91例HAP患儿，共计培养出159株病原菌，其中鲍曼不动杆菌(AB)为48株，97.9%(47/48)来自呼吸道分泌物标本。②48株AB对常用的第3、4代头孢菌素耐药率均>70%，对亚胺培南与哌拉西林/他唑巴坦耐药率均为70.8%(34/48)，对氨苄西林/舒巴坦、左氧氟沙星耐药率分别为66.7%(32/48)、27.1%(13/48)。③研究组HAP患儿PICU住院时间≥15 d、有创机械通气时间≥10 d、广谱抗菌药物使用时间≥7 d及合并先天性心脏病比例，均分别显著高于对照组，并且差异均有统计学意义(P<0.05)。

AB是PICU内HAP的重要病原菌之一，耐药性强。缩短住院时间及有创机械通气时间、合理使用抗菌药物，早期根治患儿先天性心脏病，预防肺炎反复发生，有利于预防和治疗ABHAP。

To investigate the occurrence, risk factors and antibiotic resistance characteristics of Acinetobacter baumannii hospital-acquired pneumonia (ABHAP) in the pediatric intensive care unit (PICU) for the guidance of clinical prevention and treatment of ABHAP.

Clinical data of the 91 children with hospital-acquired pneumonia (HAP) in the PICU of the West China Second University Hospital, Sichuan University were collected from September 2013 to September 2014. They were divided into study group (n=19) and control group (n=72) according to whether they were ABHAP or not. All patients′ age, gender, basic diseases, complications, immune function, the pediatric critical illness scores, hospital stay before HAP in PICU, detaining gastric tube, the duration of invasive mechanical ventilation, antibacterial drugs usage, infections with other pathogenic bacteria, drug sensitivity tests and treatment outcomes were analyzed by retrospective method. The distribution of pathogenic bacteria of children with HAP, the occurrence, antibiotic resistance characteristics and related risk factors of ABHAP in the children were analyzed by statistical methods. The procedure in this study was consistent with the Ethical Review Board of Investigation in West China Second University Hospital, Sichuan University and was approved by the committee. There were no significant differences in the age, gender ratio, pediatric critical illness score, basic disease and complications between the two groups (P>0.05).

①Among the 91 cases of children with HAP, a total of 159 strains of pathogenic bacteria were isolated, of which, there were 48 strains of Acinetobacter baumannii (AB). And 97.9% (47/48) of these 48 strains were derived from respiratory specimens. ②The resistance rate of AB to the common third-/fourth-generation cephalosporin all were over 70%, to imipenem, piperacillin/tazobactam, ampicillin/sulbactam and levofloxacin was 70.8% (34/48), 70.8% (34/48), 66.7% (32/48), and 27.1% (13/48), respectively. ③In study group, the rates of HAP patients with duration of hospitalization in PICU ≥ 15 days, duration of invasive mechanical ventilation ≥ 10 days, duration of broad-spectrum antibacterial therapy ≥ 7 days, and combined with congenital heart disease all were significantly higher than those in control group, and all the differences were statistically significant (P<0.05).

The present study shows high incidence of and severe drug-resistance to ABHAP in the PICU. Shortening the duration of hospitalization and invasive mechanical ventilation, rational use of antibiotics, early radical treatment of congenital heart disease, and prevention of recurrent pneumonia are helpful in preventing and treating ABHAP.