新生儿重症监护病房呼吸机相关性肺炎病原菌分布及耐药性分析  

Distribution and drug resistance of pathogenic bacteria of ventilator-associated pneumonia in NICU

作　　者：李淑娟[1] 刘丽丽[1] 赵俊荣[1] 李俊丽[1] 刘树艳[1] LI Shujuan;LIU Lili;ZHAO Junrong;LI Junli;LIU Shuyan(Department of Infection Management,Tangshan City Maternal and Child Health Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]河北省唐山市妇幼保健院感染管理科,063000

出　　处：《检验医学与临床》2018年第7期962-964,共3页Laboratory Medicine and Clinic

摘　　要：目的探究新生儿重症监护病房(NICU)呼吸机相关性肺炎(VAP)病原菌分布及耐药性情况。方法选取该院NICU收治的100例VAP患儿,吸痰管经气管插管来收取下呼吸道痰液标本进行细菌鉴定,采用全自动鉴定仪、药敏分析仪鉴定菌种及药敏试验,并对药敏试验结果进行对比分析。结果革兰阴性杆菌(大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌等)检出的比例(86.00%)明显高于革兰阳性球菌(金黄色葡萄球菌、溶血性葡萄球菌等)的比例(14.00%),差异有统计学意义(P<0.05)。大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌等革兰阴性杆菌致病菌对头孢他啶、头孢唑啉、头孢曲松耐药率明显高于阿米卡星、亚胺培南类耐药率,差异有统计学意义(P<0.05)。结论 VAP病原菌以革兰阴性杆菌为主,大肠埃希菌、肺炎克雷伯菌及鲍曼不动杆菌较常见,头孢类药物为首选经验性用药,存在明显耐药性,但致病菌对阿米卡星、亚胺培南类药物耐药性较低,定期监测NICU患儿VAP病原菌分布及其耐药性变迁情况,对指导临床合理用药有重要作用。Objective To investigate the distribution and drug resistance of pathogenic bacteria of ventilator-associated pneumonia(VAP)in neonatal intensive care unit.Methods A total of 100 cases of VAP patients in NICU of the hospital were selected,sampling the sputum suction tube by tracheal intubation for lower respiratory tract sputum specimens for bacterial identification,pathogenic bacteria identification and drug sensitive test were conducted,and drug sensitivity test results were compared and analyzed.Results The detection rate of gram negative bacteria(Escherichia coli,Klebsiella pneumoniae,Acinetobacter Bauman,et al)were 86.00%,which was significantly higher than those of gram positive bacteria(Staphylococcus aureus,Staphylococcus haemolyticus,et al.)account for 14.00%,the difference was statistically significant(P<0.05).The rate of gram negative bacterias such as Escherichia coli,Bauman Acinetobacter,Klebsiella pneumoniae resistant to ceftazidime,cefazolin and ceftriaxone were significantly higher than Amikacin and imipenem,the difference was statistically significant(P<0.05).Conclusion VAP pathogens are usually consist of Gram-negative bacterias including Escherichia coli,Klebsiella pneumoniae and Bauman Acinetobacter,cephalosporins is the first choice of empiric therapy,but the drug resistance is strong,while the drug resistance to Amikacin and imipenem are at a low level yet.It′s important for guiding clinical rational use of drugs by regular monitoring of NICU in VAP pathogen bacteria and antibiotic resistance.

关 键 词：新生儿重症监护病房 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]