新生儿社区获得性肺炎病原菌分布及药敏分析

The distribution of pathogenic bacteria and drug-sensitivity in newborn with community-acquired pneumonia

目的了解本地区新生儿社区获得性肺炎的病原菌分布及药敏特点,为临床经验性使用抗生素提供参考依据。方法分析2003年1月～2005年12月期间收住我院新生儿科的新生儿社区获得性肺炎的病原菌分布及药敏情况。结果新生儿社区获得性肺炎312例,送检痰标本217份,分离到阳性菌株149株,阳性率68.7%,其中革兰阴性(G-)菌占65.8%;革兰阳性(G+)菌占32.2%;真菌占2.0%。排列前五位的细菌依次为:肺炎克雷白杆菌,金黄色葡萄球菌,大肠埃希菌,表皮葡萄球菌和溶血葡萄球菌。产ESBLs肺炎克雷白杆菌株,占肺炎克雷白杆菌肺炎的5.3%。耐甲氧西林金葡菌3株、溶血性葡萄球菌2株。G-菌耐药率最高的是第三代头孢菌素;最低的是亚胺培南;其次是环丙沙星、哌拉西林/他佐巴坦、阿米卡星。而G+菌对青霉素全部耐药,对万古霉素全部敏感。结论本地区新生儿社区获得性肺炎病原菌分布以G-杆菌为主,肺炎克雷白杆菌、金黄色葡萄球菌为主要病原菌,青霉素,第二、三代头孢菌素耐药率较高,亚胺培南、万古霉素几乎全部敏感。

Objective To analyze the distribution of pathogenic bacteria and drug-sensitivity in newborn with community-acquired pneumonia in this area, and to provide a therapy reference of choosing antibi- otics for clinicans doctors. Methods The clinical records of newborn community-acquired pneumonia from January 2003 to December 2005 were retrospectively reviewed, in order to analyze the distribution of pathogenic bacteria and drug-sensitivity. Results 217 sputum specimens for culture were drawn from 312 neonates with CAP, 149 positive samples were isolated, and the positive rate was 68.7 %. Among these samples, Gram-negative bacteria accounted for 65.8 %, Gram-positive bacteria 32.2 % and epiphyte 2.0 %. Kleb- siella pneumonia, Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, and Staphylococcus haemolyticus were the most common pathogenic bacteria. There were three ESBLs KlebsieUa pneumonia isolates（5.3 % of K. pneumonia）, three MRSA isolates and two Staphylococcus haemolyticus isolates. Gram-nega- tive bacteria were the most tolerant to third-generation cephalosporin, but most sensitive to Imipenem, the oth- er sensitive antibiotics to Gram-negative bacteria were Ciprofloxacin, PiperaciUin/Tazobactam Tazocin, Amikacin. All Gram-positive bacteria were resistance to Penicillin, but sensitive to Vancomycin. Conclusion The main pathogenic bacteria of newborn CAP in this area was Gram-negative bacteria. Klebsiella pneumonia and Staphylococcus aureaus were the most important bacteria. They were highly resistant to Penicillin and third-generation cephalosporin, but sensitive to Imipenem and Vancomycin.