新生儿呼吸机相关性肺炎的病原菌培养及耐药性分析  

Pathogens causing ventilator-associated pneumonia in neonates:bacterial culture and resistance analysis

作　　者：刘汉楚[1] 鲍连生 卢珊荣[1] 王巧玲[1] 孙金枝[1] 

机构地区：[1]武汉市儿童医院新生儿科 [2]检验科,湖北武汉430016

出　　处：《中华医院感染学杂志》2011年第16期3517-3520,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析新生儿呼吸机相关性肺炎(VAP)的病原菌分布及耐药性,指导合理用药。方法回顾性分析医院2008-2009年80例VAP患儿的气管内分泌物细菌培养及抗菌药物敏感性结果。结果 80例VAP患者下呼吸道分泌物培养出病原菌130株,其中革兰阴性杆菌88株,占67.7%,革兰阳性球菌38株,占29.3%,真菌4株,占3.0%;革兰阴性杆菌以肺炎克雷伯菌和大肠埃希菌多见且产ESBLs菌株较多,对氨苄西林、阿莫西林及头孢霉素普遍耐药,但对碳青霉烯类药物敏感;革兰阳性菌以金黄色葡萄球菌和表皮葡萄球菌多见,且对青霉素、氨苄西林等耐药现象严重,但尚对万古霉素、阿米卡星及喹诺酮类则高度敏感。结论新生儿VAP的主要病原菌为革兰阴性杆菌且存在较严重的耐药现象,加强预防、适时进行细菌培养及合理选用抗菌药物,对防治新生儿VAP具有重要意义。OBJECTIVE To analyze the epidemic distribution of pathogens and tendency of drug resistance in neonatal infants with ventilator-associated pneumonia（VAP） and guide rational use of antibiotics in clinical activities.METHODS Retrospective analysis was performed on the results of tracheal secretions bacterial culture and drug sensitivity test of 80 cases of neonatal infants with VAP from 2008 to 2009 in the NICU of Wuhan Children′s Hospital.RESULTS Of 80 patients with VAP,130 strain bacteria were isolated.Among the total,there were 88 strain Gram-negative bacteria（67.7%）,38 strains Gram-positive bacteria（29.3%） and 4 strains eumycete（3.0%）.Klebsiella pneumonia and Escherichia coli were most commonly on the gram-negative bacteria and most of them were ESBLs-producing strains.The ESBLs-producing strains were serious resistant to ampicillin,amoxicillin and cefazolins,but sensitive to carbapenems.Most of gram-positive coccus was Staphylococcus aureus and Staphylococcus epidermidis which was serious resistant to penicillin and ampicillin,but was quite sensitive to vancomycin,quinolone and amikacin.CONCLUSION Most common pathogens in neonatal VAP are Gram-negative bacteria and have multiple drug resistance.It is of significance to the prevention and treatment of neonatal VAP to prevent effectively,make bacterial cultivation duly and choose antibiotics correctly.

关 键 词：新生儿 呼吸机相关性肺炎 病原菌 药物敏感性试验 耐药性 

分 类 号：R378[医药卫生—病原生物学]