新生儿肺炎病原菌分布及耐药性分析

Pathogen distribution and drug resistance analysis of neonatal pneumonia

目的研究新生儿肺炎的病原菌类型及其耐药特点,为临床预防和诊治提供依据。方法回顾性分析2014年1-12月759例新生儿肺炎下呼吸道分泌物细菌培养和药敏试验结果 ,细菌鉴定使用美国BD公司的Phoenix100细菌鉴定系统,药敏试验采用K-B纸片扩散法,结果判定以美国实验室质量标准（CLSI）2013为依据,使用WHONET5.6软件对收集的数据进行统计分析。结果 759例患儿送检痰培养标本共分离病原菌245株,阳性率为32.28%,其中革兰氏阴性菌209株、革兰氏阳性菌30株、真菌6株,分别占阳性样本的85.31%、12.24%、2.45%,革兰氏阴性菌中产超广谱β-内酰胺酶菌（ESBLs）所占比为36.84%。革兰氏阴性菌对氨苄西林的耐药率较高,耐药率为94.39%-100.00%,部分头孢菌素耐药,对阿米卡星较为敏感,对碳青霉烯类抗生素无耐药性。革兰氏阳性菌对红霉素、克林霉素耐药率较高,对万古霉素有高度敏感性。结论新生儿感染性肺炎病原菌主要为革兰氏阴性菌,对阿米卡星及碳青霉烯类抗生素相对敏感,在临床治疗新生儿肺炎时应根据药敏试验结果合理使用抗生素。

Objective To evaluate the pathogen type and drug resistance characteristics of pathogen in neonatal pneumonia to provide basis for clinical prevention and diagnosis and treatment. Methods Bacterial culture and drug sensitivity test results of lower respiratory tract secretion in 759 eases with neonatal pneumonia from January to December2012 were analyzed retrospectively.Phoenix100 system of bacterial identification in BD company of America was used for bacterial identification,Result determination took American laboratory quality standard（CLSI） 2013 as a basis,and WHONET5.6 software was used to count statistically the collected data. Results 245 strains of pathogenic bacteria were isolated from the sputum culture specimen inspected from 759 illed children,the positive rate was 32.28%,among them,209 strains were Gram negative bacteria,30 strains were Gram positive bacteria,6 strains were fungi,and and it accounted for 85.31%,12.24%,2.45% of positive sample respectively.The ratio of producing extended-spectrum β- lactamase（ESBLs） bacteria in Gram-negative bacteria was 36.84%.Gram-negative bacteria had higher drug resistantance rate to ampicillin,and drug resistantance rate was 94.39%-100.00%,partial cephalosporin was drug-fast,and it was more sensitive to amikacin,and there was no drug resistance to carbapenem antibiotics.Gram-positive bacteria has higher drug resistantance rate to erythromycin,clindamycin,and it had high sensitivity to vancomycin. Conclusion Neonatal infection pneumonia pathogens are mainly Gram negative bacteria,and relatively sensitive to amikacin and carbapenem antibiotics.In the treatment of neonatal pneumonia in clinic,antibiotics should be rationally used according to the results of drug sensitivity test.