新生儿呼吸机相关性肺炎病原菌检测及治疗探讨

The invastigation of pathogenic bacteria detection and drug sensitivity and treatment in newborns with ventilator-associated pneumonia (VAP)

目的:探讨新生儿呼吸机相关性肺炎(VAP)的病原菌及其耐药和临床治疗,为临床治疗该病起指导作用。方法:分析112例新生儿呼吸机相关性肺炎的致病菌,药敏及治疗情况。结果:(1)肺炎克雷伯杆菌为主要致病菌,占41.2%,其次为催产克雷伯杆菌(20.6%)、肺炎链球菌(12.4%)、草绿色链球菌(11.3%)。(2)肺炎克雷伯杆菌及催产克雷伯杆菌对亚胺培南最敏感,对头孢曲松、头孢哌酮、头孢呋新及氨曲南较敏感,对阿米卡星、环丙沙星轻至中度敏感。(3)肺炎链球菌及草绿色链球菌均对万古霉素敏感,对亚胺培南较敏感,对阿米卡星、环丙沙星轻至中度敏感。(4)临床上,患儿呼吸道分泌物明显增多,C反应蛋白(CRP)>5mg·L-1提示肺部感染,此时应做胸片检查及下呼吸道分泌物培养以确诊。对疑诊患者应选用广谱抗菌药物,待培养结果出来后再用敏感抗菌药物。结论:应加强NICU病房的管理以减少VAP的发生,对VAP患儿及时做呼吸道分泌物培养及药敏试验,指导临床用药。

OBJECTIVE To invastigate the pathogen and the drug sensitivity in newborns with ventilator-assorcated pneumonia and the treatment. METHODS To analyse the results of lower respiratory secretion culture and bacteria sensitivity and treatment in 112 newborns with ventilator-associated pneumonia. RESULTS （1） Klebsiella pneumonia was the most common bacterium which caused neonatal VAP（41.2%）, klebsiella oxytoca, streptococcus pneumonia and green streptococcus were also related to VAP. （2） Klebsiella pneumonia and klebsiella oxytoca were sensitive to tinem, cefuroxime, ceftriaxone, cefoperazone and aztreonam, and less to ciprofloxacin and amikacirn （3） Gram positive bacteria were sensitive to tinem and vancomycin, and less to amikacin and ciprofloxacin. （4） VAP should be suspected if the secretion increased and CRP was positive（〉5 mg·L^-1 ）, and chest Xray and secretion culture and sensitive test should be done to the suspected cases, antibiotics should be used to these babies. CONCLUSION In clinical management, preventing of infection should be emphasized. For the babies with VAP, respiratory secretion culture and drug-sensitivity test shonld be conducted for the rational use of drngs.