新生儿肺炎病原学检测及药敏分析

Analysis of neonatal pneumonia pathogen detection and susceptibility testing

目的探讨新生儿重症监护病房（NICU）新生儿肺炎的主要病原菌及其药敏情况，为临床合理使用抗菌药物提供参考依据。方法回顾性分析东莞市大朗医院2009年9月～2012年5月NICU207例新生儿肺炎患儿痰液标本分离出的病原菌及药敏情况。结果207份痰液标本中134份培养阳性，阳性率为64．73％，革兰阴性菌83株，占61．94％，革兰阳性菌47株，占35．07％，真菌4株，占2．98％。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌和肠杆菌为主，耐药性高，较敏感的抗生素为哌拉西林／他唑巴坦、阿莫西林／棒酸、头孢西丁，未见对亚胺培南、美罗培南、丁胺卡那霉素耐药的菌株。革兰阳性菌中以金黄色葡萄球菌和表皮葡萄球菌为主，金黄色葡萄球菌和表皮葡萄球菌对青霉素、苯唑西林、红霉素的耐药率达到100％，对夫西地酸、万古霉素、诺氟沙星、左旋氧氟沙星、利福平和复方磺胺甲恶唑敏感。结论新生儿肺炎以革兰阴性菌为主，应加强病原菌及药敏监测，合理使用抗菌药物。

Objective To explore neonatal pneumonia pathogens and their drug sensitivity in the neonatal intensive care unit （NICU）, and provide reference for clinical rational use of antimicrobial drugs. Methods The isolated pathogens and their drug sensitivity of 207 neonates in NICU of Dalang Hosptial from September 2009 to May 2012 were retrospectively analyzed. Results Among 207 pathogenic strains, 134 （64.73%） were identified, including 83 （61.94%） of Gram-negative bacilli, 47 （35.07%） of Gram-positive bacilli, and 4 （2.98%） of fungi. Gram-negative bacilli mainly concluded of Klebsiella pneumoniae, E Coli and erteric bacilli, which had high resistance to antimicro- bial agents, most of Gram-negative bacilli were susceptible to Piperacillin/Tazobactam, Amoxicillin/Clavulanic acid, Cefoxitin, and were not sensitive to Imipenem, Meropenem, Amikacin. Gram-positive bacilli mainly concluded of Staphylococcus aureus and staphylococcus epidermidis, the resistance rate was 100% to Penicillin, Prostaphlin and Erythrocin. And susceptible to Fusidic acid, Vancomycin, Norfloxacin, Levofloxacin, Rifampicin and Sulfamethoxazole. Conclusion Gram-negative bacilli are the main pathogens of pneumonia in neonates, Etiology and drug susceptibility monitoring should be strengthened, and antimicrobial drugs should be rational used.