新生儿感染性肺炎痰培养病原菌分布及耐药性分析  

Analysis of Bacterial Distribution and Drug Resistance in Sputum Culture of Neonates with Infectious Pneumonia

作　　者：郑申健[1] 左满凤[1] 舒琼璋[1] 董晶[1] 江玲[1] 

机构地区：[1]华中科技大学同济医学院附属孝感市中心医院,湖北孝感432100

出　　处：《儿科药学杂志》2015年第2期44-48,共5页Journal of Pediatric Pharmacy

摘　　要：目的:了解孝感市新生儿感染性肺炎病原菌的分布特点和耐药特征,指导临床合理用药。方法:选择2013年我院收治的新生儿感染性肺炎1 022例,取痰标本进行细菌培养,并采用琼脂扩散法(K-B法)进行药敏试验。结果:1 022例标本共分离病原菌408株,检出率39.92%,其中革兰阴性菌308株(75.49%),革兰阳性菌78株(19.12%),真菌22株(5.39%)。革兰阳性菌主要为金黄色葡萄球菌42株(10.29%)和肺炎链球菌22株(5.39%)。革兰阴性菌主要为大肠埃希菌126株(30.88%)、肺炎克雷伯菌84株(20.59%),二者主要为产超广谱β-内酰胺酶(ESBLs)菌,产酶率分别为52.38%(66/126)、58.33%(49/84)。ESBLs阳性菌株对氨苄西林、头孢噻肟100%耐药,对头孢唑林、头孢呋辛的耐药率>80%,对头孢他啶、头孢吡肟和氨曲南的耐药率>50%,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和碳青霉烯类抗菌药物均敏感。结论:新生儿感染性肺炎病原菌主要是以产ESBLs大肠埃希菌、肺炎克雷伯菌为代表的革兰阴性菌,二者产酶率均在52%以上,平均耐药率达58%,应根据药敏情况合理选用抗菌药物。Objective： To investigate the clinical distribution and drug resistance characteristics of pathogens causing neonatal infectious pneumonia in Xiaogan city, and provide the guide for clinical therapy. Methods： Induced sputum was extracted from 1,022 cases of neonates with infectious pneumonia collected from 2013 in our hospital, and drug sensitivity test was performed with agar diffusion method. Results ： From all the neonates, 408 strains of bacterial were isolated from induced sputum and the total detection rate was 39.92%. The gram-negative strains were detected in 308 strains （75.49%） , and the gram-positive strains were detected in 78 strains （ 19.12% ） in these 408 strains, the others were 22 fungal strains （5.39%）. The Staphylococcus aureus （ 10. 29% ） and Streptococcus pneumonia （5. 39% ） were the dominant bacteria in gram-positive bacteria. The gram-negative bacterias mainly were Eseherichia eoli （30.88%）, Klebsiella pneumoniae （20.59%）, which could produce extended-spectrum β-1actamases （ESBLs, the rates of enzyme production were 52.38% and 58.33% ）. ESBLs-producing baeterias were highly resistanct to ampicillin, cefotaxime （the resistance rate were 100% ）, and the resistance rate to eefazolin and cefuroxime were 〉 80%, and the resistance rates to eeftazidime, eefepime, aztreonam were 〉 50%, but they were sensitive to cefoperazone/sulbactam, piperacillin/tazobactam, carbapenems. Conclusion： ESBLs-producing Escherichia eoli and KlebsieUa pneumoniae were the main pathogenic bacteria causing neonatal infectious pneumonia, the main rate of enzyme production accounted above for 52% , and average resistance rate was 58%. Antibiotics should be chosen according to resistance analysis.

关 键 词：新生儿 感染 肺炎 细菌 耐药性 

分 类 号：R722.1[医药卫生—儿科]