2014-2017年某院NICU新生儿感染性肺炎病原菌分布及耐药性变迁

Distribution and antibiotic resistance of pathogens in neonatal pneumonia in a hospital from 2014 to 2017

目的探讨某医院新生儿肺炎病原菌分布及细菌耐药性变迁,指导临床合理选用抗菌药物。方法回顾性分析新生儿肺炎痰培养阳性及药敏试验结果。结果 4年共收集1340份检测标本,分离出26种常见病原菌457株,阳性分离率为34.1%,其中G+菌115株、G-菌342株,分别占分离菌株的25.2%和74.8%。各年的细菌构成变化不大。前5位分离出的细菌依次是大肠埃希菌(26.7%)、肺炎克雷伯杆菌(20.3%)、金黄色葡萄球菌(11.6%)、阴沟肠杆菌(9.6%)和表皮葡萄球菌(8.3%)。主要G-菌对抗菌药物耐药性呈波动性变化,其中大肠埃希菌及肺炎克雷伯杆菌的耐药率有上升趋势,总体对氨苄西林耐药率高,对头孢他啶、β内酰胺类、阿米卡星、碳青霉烯类敏感性较高。已出现了耐碳青霉烯类的肺炎克雷伯杆菌及阴沟肠杆菌。革兰氏阳性菌以金黄色葡萄球菌为主,各年的耐药率无明显差异,未发现对万古霉素及替考拉宁耐药的菌株。结论某院新生儿肺炎常见的致病菌以G-菌(大肠埃希菌及肺炎克雷伯杆菌)为主,不同类型的病原菌对抗菌药物的敏感性不同,且已分离出耐碳青霉烯类的肠杆菌,临床应根据药敏检测结果合理选择抗菌药物。

Objective To investigate the distribution characteristics of the pathogenic microorganism and tendency of antibiotic resistance of neonatal pneumonia at NICU in our hospital,in order to clarity the characteristics of pathogens and to guide clinical rational selection of antibiotics.Methods The bacterial culture and drug sensitivity of sputum samples in our hospital were analyzed retrospectively.Results 1 340 samples for testing were collected,and a total of 26 kinds 457 pathogenic bacterial strains were isolated,positive isolation rate being 34.1%,including 115(25.2%)Gram-positive bacteria and 342(74.8%)Gram-negative bacteria.The composition of main bacteria in each year had little change.The first five pathogenic bacteria were Escherichia coli(26.7%),Klebsiella pneumonia(20.3%),Staphylococcus aureus(11.6%),Enterobacter cloacae(9.6%),Staphylococcus epidermidis(8.3%).The drug resistance rate of the main leather gram-negative bacteria to commonly used antibiotic fluctuated,the drug resistance of Escherichia coli and Klebsiella pneumoniae were in a rising trend.Overall,gram-negative bacteria were highly resistant to ampicillin and highly sensitive to ceftazidime,beta-lactase,amikacin and carbapenems.Carbapenem-resistant Klebsiella pneumoniae and Enterobacter cloacae was found.The main gram-positive bacteria were Staphylococcus aureus and the resistant rate did not change during 4 years.No resistance to vacocin vancomycin and teicoplanin was found.Conclusion Gram-negative bacilli predominates the pathogens of lower respiratory tract infection in neonates,especially Escherichia coli and Klebsiella pneumoniae.Different bacteria show different drug resistances.Carbapenem-resistant Enterobacteriaceae has been found.