早产儿呼吸机相关性肺炎病原菌分析  

Analysis of pathogens for premature ventilator-associated pneumonia.

作　　者：李耘[1] 吕回[1] 卫巧贤[1] 

机构地区：[1]广州市儿童医院新生儿病区,510120

出　　处：《中国实用儿科杂志》2003年第8期472-474,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的 了解早产儿呼吸机相关性肺炎(VAP)的主要病原菌及药物敏感情况,指导临床正确使用抗生素。方法 对1998年1月至2002年3月NICU收住早产儿中符合VAP诊断标准的38例患儿,于撤离呼吸机时取气管导管末端做细菌培养及药物敏感试验。结果 38例患儿中29例细菌培养阳性,检出率76.32％;机械通气>7d者7例,检出率100％。检出病原菌31株,铜绿假单胞菌、血浆凝固酶阴性葡萄球菌、肺炎克雷伯菌为主要病原菌,耐药率极高,对庆大霉素、哌拉西林,甚至部分第三代头孢菌素耐药率在50％以上,对万古霉素、喹诺酮类、亚胺培南较为敏感。结论 检测发现革兰阴性杆菌,尤以铜绿假单胞菌、肺炎克雷伯菌是早产儿VAP的主要病原菌,但血浆凝固酶阴性葡萄球菌感染有上升的趋势,超过肺炎克雷伯菌,位居第二,应引起注意,积极防治。Objective To investigate the main pathogens of ventilator-associated pneumonia( VAP) in premature infants and sensitivity of drugs,in order to use antibiotics reasonably. Methods 38 premature infants from NICU during Jan 1998 to March 2002,all diagnosed by criteria of VAP, were performed with bacteria culture and drug sensitivity tests at the terminal tracheocatheter when disconnected from respirator. Results Of the 38 cases,29 were positive, the detection rate being 76.32% ;7 cases used mechanical ventilation for more than seven days,and the detection rate was 100% . Of 31 strains of delected bactertia, pseudomonas aeruginosa, plasma coagulase-negative staphylococcus and klebasiella pneumoniae were the main pathogens and the drug resistance was very high - the resistant rate to gentamycin, piperacillin and some of the third generation of cephalosporin amounted to 50 percent;but they were relatively sensitive to vancomycin, quinolone and imipenem. Conclusion Gram negative bacteria, especially pseudomonas aerugincxsa and klebasiella pneumoniae,are the main pathogenic bacteria of premature VAP,but the infection with plasma coagulase-neg-ative staphylococcus is on the rise, taking the place of klebasiella pneumoniae, as the second main bacterium. Efforts should be made for its prevention and treatment.

关 键 词：早产儿 呼吸机相关性肺炎 病原菌 药物敏感试验 诊断 治疗 

分 类 号：R722.6[医药卫生—儿科] R725.631[医药卫生—临床医学]