早产儿呼吸机相关性肺炎病原菌分析

Analysis on pathogens of ventilator-associated pneumonia in premature infants

目的：调查早产儿呼吸机相关性肺炎病原菌的分布及耐药特点，指导临床合理用药。方法：分析2007年3月～2008年3月发生呼吸机相关性肺炎的64例早产儿的病原菌谱及耐药性。结果：64例呼吸机相关性肺炎患儿中28例分泌物培养阳性，阳性率43．75％，培养出病原菌32种。其中G^-杆菌阳性24例（占75．00％），G^＋球菌阳性7例（占21．88％），合并真菌感染（假丝酵母菌）1例。G^-杆菌中ESBLs分离率29．9％，葡萄球菌中BLs分离率66．67％；G^-杆菌中ESBLs阳性者仅对美洛培南及阿米卡星高度敏感，葡萄球菌BLs阳性者仅对万古霉素敏感。结论：早产儿呼吸机相关性肺炎病原菌以G^-杆菌为主，G^＋球菌次之，同时合并真菌的感染，致病菌耐药率高，临床医师应根据病原菌以及药敏试验合理选择抗菌药物。

Objective： To investigate the distribution of pathogens of ventilator - associated pneumonia （VAP） in premature infants and characteristics of antimicrobial resistance, direct rational administration of drug in clinic. Methods ： Bacterial Spectrum and drug resistance of 64 premature infants with VAP were analyzed from March 2007 to March 2008. Results： The positive rate of secretion from 64 premature infants was 43.75 % （28/64） , 32 bacteria strains were isolated, the percentages of gram - negative bacilli and gram - positive cocci were 75. 00% （24/32） and 21.88% （7/32）, and mycotic infection was found in one case. The isolated rate of ESBLs in gram -negative bacilli was 29. 9% , and the isolated rate of BLs in staphylococci was 66. 67% ; gram - negative bacilli with positive ESBLs were sensitive to meropenem and amikacin; staphylococci with positive BLs were sensitive to vancomycin. Conclusion： Gram - negative bacilli are the main pathogens of VAP in premature infants, the secondary is gram - positive cocci, drug resistance is high, clinicians should choose antimicrobial agents according to pathogen and antimicrobial susceptibility test result.