新生儿呼吸机相关性肺炎病原菌变迁及药敏性分析  

Changes and Drug Sensitivity of Pathogenic Bacteria of Ventilator-Associated Pneumonia in Neonates

作　　者：欧阳颖[1] 方建培[1] 麦友刚[1] 苏浩彬[1] 吴燕云[1] 

机构地区：[1]中山大学孙逸仙纪念医院儿科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2012年第5期644-648,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科学技术研究基金(A2010161)

摘　　要：【目的】探讨新生儿呼吸机相关性肺炎(VAP)病原菌的变迁和耐药情况。【方法】选择本院新生儿区2004年1月至2012年1月入院的机械通气时间≥48 h的VAP患儿58例,并将前后4年的病例分成2组,将病原学情况进行比较及分析其耐药情况。【结果】2004年1月至2008年1月从26例VAP患儿中分离出病原菌株数为38株,主要为嗜麦芽窄食单胞菌(8株)、溶血葡萄球菌(5株)、铜绿假单胞菌(4株)、屎肠球菌(4株)、阴沟肠杆菌(3株);2008年1月至2012年1月从32例VAP患儿中分离出42株病原菌。主要病原菌株为表皮葡萄球菌(7株)、肺炎克雷白杆菌(4株)、溶血葡萄球菌(4株)、鲍曼不动杆菌(4株)、屎肠球菌(4株)。嗜麦芽窄食单胞菌仅对左氧氟沙星、替卡西林/棒酸等较敏感,其他的革兰阴性杆菌对碳青霉烯类、左氧氟沙星以及阿米卡星等耐药率较低;革兰阳性球菌对万古霉素、替考拉宁、利奈唑烷无耐药性,对其他的抗生素有较广泛耐药性。【结论】VAP致病菌耐药形势严峻,以多药耐药的条件致病菌为主,近年来VAP致病菌谱发生显著改变。[ Objective ] To investigate the changes of pathogens and drug sensitivity of pathogenic bacteria of neonatal ventilator- associated pneumonia （VAP）. [Methods] Retrospective analysis was performed on the clinical data of 58 mechanical ventilated （I〉 48 h） patients who were diagnosed VAP in NICU from January 2004 to January 2012. And they were divided into two groups according to the time of disease occurrence to study the changes of isolated pathogens and drug sensitivity of pathogenic bacteria. [Results] 38 strains of pathogens were isolated from 26 patients with VAP from January 2004 to January 2008, the main pathogenic bacteria include ： 8 strains of Stenotrophomonas maltophilia, 5 strains of Staphylococcus haemolyticus, 4 strains of Pseudomonas aeruginosa, 4 strains of Enteroloccus faecium, 3 strains of Enterobacter cloacae. 42 strains of pathogens were isolated from 32 patients with VAP from January 2008 to January 2012, the main pathogenic bacteria include： 7 strains of Staphylococcus epidermidis, 5 strains of Klebsiell, 4 strains of Staphylococcus haemolyticus, 4 strains of Acinetobacter baumannii, 4 strains of Enteroloccus faecium. Stenotrophomonas maltophilia were partially sensitive to Levofloxacin and Ticacillin/ca. Other gram-negative bacillus were sensitive to Carbopenem antibiotics, Levofloxacin and Amikacin; Gram-positive bacillus were all sensitive to Vancomycin, Tiecoplanin, and Linezolid. [conclusion ] The pathogenic bacteria has severe drug resistance. The main isolated pathogens are usually multi-drug resistance opportunistic bacteria. The spectrum of pathogenic bacteria was significantly changed in the past eight year.

关 键 词：新生儿 呼吸机相关性肺炎 病原菌 

分 类 号：R563.1[医药卫生—呼吸系统]