De Souza Bradley, Richardson Susan E, Cohen Eyal, Mahant Sanjay, Avitzur Yaron, Carsley Sarah, Rapoport Adam
Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada.
Division of Microbiology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
Children (Basel). 2020 Sep 29;7(10):154. doi: 10.3390/children7100154.
This prospective cohort study aimed to: (1) describe types, concentrations and sensitivity profiles of bacteria found in gastric aspirates of neurologically impaired children; (2) compare flora between outpatients and those admitted with aspiration pneumonia; and (3) examine predictors of bacterial colonization. Gastric aspirates from gastrostomy fed, neurologically impaired children on antacid medication were measured for pH and sent for microbiological testing. The outpatient arm included 26 children at their baseline; the inpatient arm included 31 children with a clinical diagnosis of aspiration pneumonia. Descriptive statistics summarized the ecology and resistance patterns of microbial flora. Predictors of total bacterial colonization were explored with linear regression. High concentrations of potentially pathogenic fecal-type bacteria were detected in 50/57 (88%) gastric aspirates. pH was found to be the only predictor of bacterial growth; children with gastric pH ≥ 4 had significantly higher concentrations of aerobic growth, while those with no bacterial growth had a pH < 4. Further studies to evaluate optimal gastric pH, the role of gastric bacteria in causing aspiration pneumonia, and the optimal empiric therapy for aspiration pneumonia are recommended.
（1）描述神经功能受损儿童胃吸出物中发现的细菌类型、浓度和敏感性概况；（2）比较门诊患者与因吸入性肺炎入院患者的菌群；（3）检查细菌定植的预测因素。对通过胃造口喂养、服用抗酸药物的神经功能受损儿童的胃吸出物进行pH测量，并送去进行微生物检测。门诊组包括26名处于基线状态的儿童；住院组包括31名临床诊断为吸入性肺炎的儿童。描述性统计总结了微生物菌群的生态和耐药模式。通过线性回归探索总细菌定植的预测因素。在57份胃吸出物中的50份（88%）中检测到高浓度的潜在致病性粪便型细菌。发现pH是细菌生长的唯一预测因素；胃pH≥4的儿童有氧生长浓度显著更高，而没有细菌生长的儿童pH<4。建议进一步研究以评估最佳胃pH、胃细菌在引起吸入性肺炎中的作用以及吸入性肺炎的最佳经验性治疗。
