2164例新生儿肺炎需氧菌的分布及耐药性分析

Distribution and drug resistance of aerobic bacteria isolated from 2 164 neonates with pneumonia

目的 了解新生儿肺炎病原菌的分布及耐药情况 ,为临床合理选用抗菌药物提供依据。方法 对某院新生儿科 1999年 1月～ 2 0 0 3年 12月临床疑为呼吸道感染的新生儿 ,无菌取痰进行普通培养和高渗培养。用法国生物梅里埃系统鉴定细菌 ,以K B法进行药敏试验 ,用双纸片法检测超广谱 β 内酰胺酶 (ESBLs)。 结果 2 16 4份标本检出需氧菌 1189株 ,阳性率 5 4 .94 % ;其中革兰阴性 (G-)杆菌 4 2 8株 ,占 36 .0 0 % ,革兰阳性 (G+ )球菌 6 4 8株 ,占 5 4 .5 0 % ,其他菌种 113株 ,占 9.5 0 %。从肠杆菌科细菌中检出产ESBLs菌 78株 (2 5 .4 9% )。G-杆菌对亚胺培南、环丙沙星、头孢他啶、阿米卡星等较敏感 ,G+ 球菌对万古霉素、亚胺培南、头孢噻肟、利福霉素、头孢哌酮等较敏感。结论 新生儿肺炎病原菌以G+ 球菌为主 ,且有上升趋势 ,尤其是葡萄球菌上升明显 ;肠杆菌科细菌常有较高耐药性 ,产ESBLs菌对亚胺培南的敏感性高。

Objective To evaluate the distribution and drug resistance of bacteria causing neonatal pneumonia, and to provide evidences for clinic to select antimicrobial agents rationally. Methods Sputum samples from 2 164 neonates with suspected respiratory tract infection in a hospital from January, 1999 to December, 2003 were cultured by general and high-osmosis methods, bacteria were identified by API system. Antimicrobial susceptibility tests were performed by Kirby-Bauer method, ESBLs in the isolated Gram negative bacilli were detected by double-disk test. Result 1 189 (54.94%) strains of aerobic bacteria were isolated from the 2 164 specimens. 428 (36.00%) were gram negative bacilli, 648 (54.50%) were gram positive cocci, 113 (9.50%) were other bacteria. 78 (25.49%) ESBLs positive strains were trains of Enterobacteriaceal. Gram negative bacilli were susceptible to imipenem, ciprofloxacin, ceftazidime and amikacin, Gram positive cocci were susceptible to vancomycin, imipenem, cefotaxine, rifampicin and cefoperazone. Conclusion Gram positive cocci are the main bacteria in neonatal pneumonia. gram positive cocci, especially Staphylococcus are more and more prevalent in neonatal respiratory tract infection. Strains of Enterobacteriaceae are usually have drug resistance, imipenem is the best drug to treat the patients infected with ESBLs-producing strains.