新生儿社区获得性肺炎病原菌分布及药敏分析

Distribution of pathogenic bacteria and drug susceptibility in newborn with community-acquired pneumonia

目的调查新生儿社区获得性肺炎的病原菌分布及药物敏感状况,以利于临床合理选用抗菌药物。方法采用回顾性调查方法,调查2008年1月-2010年12月收住在新生儿重症监护病房(NICU)的298例社区获得性肺炎新生儿的临床资料,并分析痰液标本所分离病原菌的菌种分布及药敏分析。结果 298例中共有178例患儿痰培养呈阳性,阳性率为59.7%;其中以革兰阴性菌为主,占73.6%,前3位的是大肠埃希菌、肺炎克雷伯菌、流感嗜血菌,分别为31.5%、16.9%、14.6%;革兰阳性菌占24.7%,以金黄色葡萄球菌7.9%、凝固酶阴性葡萄球菌(表皮葡萄球菌7.3%、人葡萄球菌6.2%)为主;真菌占1.7%,革兰阴性菌耐药率最高的是氨苄西林,最低的是亚胺培南;其次是左氧氟沙星;革兰阳性菌耐药率最高的是青霉素,最低的是万古霉素、庆大霉素、环丙沙星、磺胺甲噁唑/甲氧苄啶。结论分析社区获得性肺炎的病原菌谱、细菌变化,加强细菌药物检测,合理选用抗菌药物,以利于针对性治疗。

OBJECTIVE To investigate the distribution and drug susceptibility in newborn with community-acquired pneumonia so as to provide a reasonable basis for antimicrobial agent selection.METHODS In order to analyze the distribution of pathogenic bacteria and drug susceptibility,clinical date of 298 cases of newborn with community-acquired pneumonia in NICU from January 2008 to December 2010 were retrospectively analyzed.RESULTS 178 positive cases were determined with the positive rate of 59.7%.Among these isolates,majority were gram-negative basilli（73.6%）.The most frequently detected organisms were Escherichia coli（31.5%）,followed by Klebsiella pneumonia（16.9%） and Hemophilus influenza（14.6%）.Gram-positive bacteria accounted for 24.7%,of which the majority were Staphycococcus aureus（7.9%） and Coagulase negative Staphycococcus（S.epidermidis 7.3%,S.hominis 6.2%）;fungi bacteria accounted for 1.7%.Gram-negative bacteria had the highest resistant rate to ampicillin,and lowest to imipenem;the other sensitive antibiotics to gram-negative bacteria were levofloxacin.Gram-positive bacteria were most resistant to Penicillin,but susceptible to vancomycin,gentamicin,ciprofloxacin,CME-TMP.CONCLUSION Analyzing bacterium regulation,transmutation,drug susceptibility of neonatal omphalitis can provide a reasonable basis for selection and targed therapy.