新生儿重症监护病房呼吸机相关性肺炎病原学分析

Analysis of bacteria etiology of neonates with ventilator-associated pneumonia in NICU

目的探讨新生儿重症监护病房(NICU)呼吸机相关性肺炎(VAP)病原菌特点及药敏情况,为临床治疗VAP提供科学依据。方法对2008年1月～2010年6月本院NICU 102例VAP病例进行深部痰培养,对其病原菌分布及药敏进行分析。结果 102例VAP患者中86例痰培养阳性,其中革兰氏阴性菌73例(82.95%),对β-内酰胺类抗菌素普遍耐药,对丁胺卡那中度敏感,对亚胺培南、环丙沙星敏感。革兰氏阳性球菌13例(14.77%),对青霉素、红霉素均耐药,对头孢菌素类抗菌素普遍耐药,对环丙沙星中度敏感,对万古霉素敏感。真菌2例,对氟康唑敏感。结论 NICU中VAP病原菌以革兰氏阴性菌为主,其次为革兰氏阳性球菌,两者均对常用抗菌素如头孢菌素类等普遍耐药;大部分革兰氏阴性菌对亚胺培南敏感,革兰氏阳性球菌对万古霉素敏感。

Objective To survey the characteristics of bacteria causing ventilator- associated pneumonia （VAP） in NICU, and to give the direction for antibiotic treatment in clinic for VAP. Methods 102 patients registered with a diagnosis of VAP between January 2008 and June 2010 were included in the study. We hereby present a retrospective study on distribution of pathogenic bacteria and characteristics of drug - resistant bacteria. Resuits 86 cases of 102 patients diagnosed with VAP met the positive criteria of bacterial culture. The most common findings among the 88 VAP episodes were Gram - negative bacillus（73, 82.95% ） in newborns in NICU. They were highly resistant to β- lactam antibiotics, and moderately sensitive to amikacin, but sensitive to tienam and ciprofloxacin. Gram - positive cocci in 13 cases, accounting for 14.77% are resistant to penicillin, erythromycin, resistance in general to cephalosporins antibiotic, moderately sensitive to ciprofloxacin, and Sensitive to vancomycin. Fungi in 2 cases are sensitive to fluconazole. Conclusion Gram- negative bacteria are the main pathogens causing VAP in newborns in NICU, the next are gram - positive bacteria, and all of them have high drug- resistant for common antibiotic. Most gram- negative bacteria are sensitive to imipenem, and gram - positire bacteria are sensitive to vancomycin. Clinicians should choose antimicrobial agents according to the pa and antimicrobial susceptibility test.