目的 探讨大面积烧伤患儿静脉导管感染病原菌情况,分析其耐药性。方法 选取2014-01至2019-01武警辽宁总队医院和解放军总医院第三医学中心烧伤科收治的478例烧伤患儿,收集所有患儿的静脉导管进行细菌培养与鉴定,对按不同因素分类的置管后患儿中心静脉导管感染情况进行对比分析。结果 478例静脉导管中共分离出病原菌304株。其中革兰阳性菌113株(37.17%),革兰阴性菌183株(60.20%),真菌8株(2.63%)。药敏试验显示:金黄色葡萄球菌对万古霉素和利奈唑胺敏感;铜绿假单胞菌对哌拉西林/他唑巴坦和亚胺培南敏感。男女感染率对比差异无统计学意义,不同年龄患儿感染率对比,差异有统计学意义(P<0.05);中心静脉导管穿刺部位股、颈内、锁骨下静脉感染率、导管留置及住院时间不同感染率对比,差异均有统计学意义(P<0.05)。结论 大面积烧伤患儿年龄越小感染率越高,股静脉感染率较重,留置、住院时间越长感染率越高。

Objective To investigate the pathogens of venous catheter infections in children with large-area burn and analyze their drug resistance. Methods Between January 2014 and January 2019, 478 burn patients were selected from the Burn Department of our hospital and the Third Medical Center of the PLA. All the venous catheters used by these patients were collected for bacterial culture and identification. Results Three hundred and four strains of pathogenic bacteria were isolated from the 478 children with extensive burn. There was significant difference in the infection rate of the femoral vein, internal jugular vein and subclavian vein at the puncture sites of cardiac venous catheters (P<0.05), and in the duration of catheter retention and hospitalization (P<0.05). These strains of pathogenic bacteria included 113 (37.17%) strains of Gram-positive bacteria, 183 (60.20%) strains of Gram-negative bacteria and 8(2.63%) strains of fungi. Drug sensitivity test showed that Staphylococcus aureus was sensitive to vancomycin and linezolid, while Pseudomonas aeruginosa was sensitive to piperacillin/tazobactam and imipenem. Conclusions The younger the children with large-area burn, the higher the infection rate, the higher the infection rate of the femoral vein. The longer their hospital stay, the higher the infection rate.