Objective To study change and characteristics of pathogens for pediatric pyothorax before and after thoracotomy, and the rational choice of antibacterial drugs. Methods There were 24 cases of pediatric pyothorax receiving thoracotomy. According to preoperative and postoperative pathogen culture and drug sensitivity test results, the choice of antimicrobial drugs was determined. The relations between the change of pathogenic types, the progression of the disease and drug choice were observed. Results There were 13 cases in 24 cases occurred different types of pathogens before and after the surgery. The sensitivity of the drug also correspondingly changed. Conclusion Long infected course of pediatric pyothorax causes, the change of pathogens, intraoperative and postoperative culture and drug sensitivity test are especially important. It is unreliable for drug choice relied on experience or a single time of bacterial culture result.%目的：探讨小儿脓胸开胸手术前后致病菌的种类变化及其特点，以及抗菌药物的合理选择。方法24例小儿脓胸行开胸手术治疗，根据术前术后致病菌培养及药物敏感试验结果进行抗菌药物的选择治疗，观察其致病菌种类的变化与病情发展变化及药物选择的关系。结果24例患儿中有13例出现术后致病菌与术前致病菌种类不同，对药物的敏感性亦出现相应的变化。结论小儿脓胸因感染病程周期长，致病菌处于动态变化之中，术中术后的脓液培养及药物敏感试验尤为重要，单靠经验用药及单次的细菌培养结果指导用药并不可靠。
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