目的 分析溺水后吸入性肺炎患儿的临床特征及病原特点，为抗菌药物的经验性选择提供参考。 方法 回顾性收集重庆医科大学附属儿童医院2010年1月至2020年10月收治的185例溺水后吸入性肺炎患儿的临床资料，按淹溺环境分为溺粪组（44例）、自然淡水组（69例）、游泳池组（41例）、污水组（31例），分析比较4组患儿的临床特征及病原结果。 结果 185例患儿，年龄4月龄至17岁，中位年龄34月龄。共157例患儿完善痰培养，103例阳性（65.6%），检出革兰阴性菌87株（68.5%），革兰阳性菌37株（29.1%），真菌3株（2.4%）。溺粪组、污水组检出病原以革兰阴性菌为主，分别为88.2%（30/34）、78.3%（18/23）。自然淡水组革兰阳性菌检出比例高于溺粪组（P<0.008）。游泳池组革兰阳性菌与革兰阴性菌检出比例相等。 结论 溺粪及污水溺水者考虑肺部细菌感染时可考虑选择对革兰阴性菌作用强的抗生素，游泳池及自然淡水溺水者可应用广谱抗生素，根据药敏试验结果进一步调整。
Abstract
Objective To study the clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia, so as to provide a reference for empirical selection of antibacterial agents. Methods A retrospective analysis was performed on the medical data of 185 children with drowning-associated aspiration pneumonia who were admitted to Children's Hospital of Chongqing Medical University from January 2010 to October 2020. According to the drowning environment, these children were divided into four groups: fecal group (n=44), freshwater group (n=69), swimming pool group (n=41), and contaminant water group (n=31). The clinical characteristics and pathogen detection results were reviewed and compared among the four groups. Results The 185 children had an age of 4 months to 17 years (median 34 months). Sputum cultures were performed on 157 children, and 103 were tested positive (65.6%), with 87 strains of Gram-negative bacteria (68.5%), 37 strains of Gram-positive bacteria (29.1%), and 3 strains of fungi (2.4%). Gram-negative bacteria were the main pathogen in the fecal group and the contaminant water group, accounting for 88.2% (30/34) and 78.3% (18/23), respectively. The freshwater group had a significantly higher detection rate of Gram-positive bacteria than the fecal group (P<0.008), and the swimming pool group had an equal detection rate of Gram-negative bacteria and Gram-positive bacteria. Conclusions For pulmonary bacterial infection in children with drowning in feces or contaminant water, antibiotics against Gram-negative bacteria may be applied empirically, while for children with drowning in a swimming pool or freshwater, broad-spectrum antibiotics may be used as initial treatment, and subsequently the application of antibiotics may be adjusted according to the results of the drug sensitivity test.
关键词
溺水 /
吸入性肺炎 /
病原 /
儿童
Key words
Drowning /
Aspiration pneumonia /
Pathogen /
Child
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