新生儿社区和医院感染性肺炎的病原学特点和细菌药敏分析

Distribution of pathogen and analysis of drug sensitivity in newborns with either community-acquired pneumonia or hospital-acquired pneumonia

目的探讨引起新生儿社区感染性肺炎(CAP)和医院感染性肺炎(HAP)的病原分布,并对细菌耐药性进行分析,以指导临床防治。方法对2006年1月-2007年12月收治的新生儿社区和医院感染性肺炎患儿痰标本进行病原检测,用KB法测定病原菌耐药性。结果117例CAP共检出138株病原微生物,其中细菌89株(64.5%),病毒42株(30.4%)。细菌以金黄色葡萄球菌(22株,55.0%)、大肠埃希菌(18株,36.7%)为主,前者对β内酰胺类抗生素敏感率较高,对青霉素、红霉素耐药率高,后者对第三代头孢菌素的耐药率较高,对环丙沙星、哌拉西林/他唑巴坦、阿莫西林/克拉维酸钾、头孢哌酮/舒巴坦、亚胺培南等敏感性较高。CAP中病毒感染以呼吸道合胞病毒(RSV)为主(34株,81.0%),起病时间集中于12月至次年4月。58例HAP中47例为呼吸机相关肺炎(VAP),HAP共检出54株病原微生物,其中细菌主要为鲍氏不动杆菌(18株,46.1%)及肺炎克雷伯菌(9株,23.1%),两者均有较明显的耐药及多重耐药现象。HAP共分离病毒8株,均为RSV,起病时间集中于11月至次年3月。HAP及CAP中G-杆菌产ESBLs菌分别占31.58%及38.64%。结论新生儿肺炎的临床治疗及选用抗生素,应考虑到医院内及社区感染的致病菌谱差别及其耐药情况。住院患儿应注意预防、积极治疗VAP。RSV为冬春季节HAP的主要病原体之一,对RSV感染患儿应采取有效隔离,避免引起院内流行。

Objective To investigate the distribution of the pathogen and its drug sensitivity in neonates with either community-acquired pneumonia （CAP） or hospital-acquired pneumonia （HAP） in a level m medical center of Shanghai for further guiding the prevention and treatment of the diseases. Methods Clinical records were retrospectively analyzed in newborns with either CAP or HAP admitted in Children＇s Hospital of Fudan University during Jan, 2006 to Dee, 2007. The specimens of the sputum from newborns with either CAP or HAP were collected for the detection of pathogen, and the drug resistance was measured by using K2B method. Results One hundred and thirty-eight pathogenic strains were detected from the specimens of ll7 neonates with CAP. Staphylococcus aureus （22 strains, 55%） which was sensitive to β-lactam antibiotics and Escherichia coli （18 strains, 36.7% ） which was resistant to third-generation cephalosporin were the major pathogenic bacteria, and Respiratory Syncytial Virus （RSV） was the most common （34 strains, 84% ） pathogenic virus in newborns with CAP. Forty-seven cases of 58 newborns with HAP were diagnosed as ventilator-associated pneumonia. Fifty-four pathogenic strains were separated from the specimens of 58 newborns with HAP. Acinetobacter baumanni （18 strains, 46.1%） and Klebsiella pneumonia （9 strains, 23.1% ） were the most common pathogenic bacteria and all with high drug-resistance and multidrug-resistance. RSV was only pathogenic virus isolated from the specimens of 8 newborns with HAP. The positive rates of ESBLs in Gram-negativerods were 31.58% in HAP and 38.64% in CAP. Conclusions Distribution of pathogen and drug sensitivity should be considered in the antibiotics treatment of either CAP or HAP in neonates. VAP should be prevented and treated early in hospitalized newborns. The neonates with RSV infection which is one of the most common pathogens in HAP in winter and spring should be isolated to prevent the outbreak of RSV in NICU.