2010—2013年新生儿感染性肺炎病原体分布及耐药性分析

Distribution and antimicrobial resistance of pathogens in neonatal infectious pneumonia between 2010 and 2013

目的分析某院新生儿感染性肺炎分离的病原体分布及耐药情况。方法对2010年1月—2013年12月该院新生儿科及儿科重症监护室送检的新生儿痰液和气管插管末端采样标本进行培养,对分离菌株进行鉴定和药敏试验。结果共检出病原体3 278株,其中革兰阳性菌1 391株(42.43%),革兰阴性菌1 884株(57.47%),真菌3株(0.09%)。病原体中居前5位的是金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、表皮葡萄球菌和溶血葡萄球菌,分别占22.82%、20.01%、17.33%、6.96%和4.94%。肺炎克雷伯菌和大肠埃希菌的超广谱β-内酰胺酶检出率分别为66.46%、66.55%。药敏结果显示,肺炎克雷伯菌和大肠埃希菌对哌拉西林/他唑巴坦、头孢吡肟和头孢替坦较敏感(敏感率>84%),金黄色葡萄球菌和表皮葡萄球菌对氨苄西林/舒巴坦、磷霉素和利奈唑胺敏感率达100%。结论对新生儿感染性肺炎进行病原体监测,有助于了解新生儿感染病原体的流行趋势及耐药特点,以便合理用药,治疗新生儿感染性肺炎。

Objective To evaluate distribution and antimicrobial resistance of pathogens in neonatal infectious pneumonia. Methods Sputum specimens and ends of tracheal intubation of neonates at neonatal intensive care unit and pediatric intensive care unit between January 2010 and December 2013 were cultured, and isolated pathogens were identified and performed antimicrobial susceptibility testing. Results A total of 3 278 pathogenic isolates were isolated, I 391 （42.43%） were gram-positive cocci, 1 884 （57.47 % ） were gram-negative bacilli, and 3 （0.09% ） were fungi. The top five pathogens were Staphylococcus aureus （22.82% ）, Klebsiella pneumoniae （20.01% ）, Escherichia coli（ 17.33% ）, Staphylococcus epidermidis （6.96 % ）, and Staphylococcus haemolyticus （4.94% ）.The detection rate of extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli was 66. 46% and 66.55 %, respectively. Susceptibility rate of Klebsiella pneumoniae and Escherichia coli to piperacillin / tazobactam, cefepime and cefotetan were〉84, susceptibility rates of Staphylococcus aureus and Staphylococcus epidermidis to ampicillin / sulbactam,fosfomycin and linezolid were all 100%. Conclusion Monitoring on pathogens in neonatal infectious pneumonia is helpful for realizing the epidemiological trend and drug resistance characteristics, and can promote the rational use of antimicrobial agents for the treatment of neonatal infectious pneumonia.