NICU新生儿呼吸机相关性肺炎病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing ventilator-associated pneumonia in neonates of NICU

目的分析新生儿呼吸机相关性肺炎(VAP)的病原菌分布及耐药性,为合理制定抗感染治疗方案提供客观依据。方法选取2013年1月-2014年12月在新生儿重症监护病房(NICU)住院治疗发生VAP的新生儿60例作为研究对象,采集新生儿痰液标本进行培养,应用全自动微生物鉴定系统进行病原菌鉴定,应用K-B纸片扩散法进行药敏试验,应用WHONET 5.3软件对药敏结果进行统计分析。结果 60例VAP新生儿送检标本培养出病原菌45株,阳性检出率为75.0%,检出的病原菌均为革兰阴性菌,以肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌检出最多,分别占31.1%、28.9%和20.0%,3种病原菌对临床常用抗菌药物的耐药性均较高,其中肺炎克雷伯菌、大肠埃希菌对多数头孢菌素类抗菌药物的耐药率均达到100.0%,对环丙沙星、阿米卡星等抗菌药物均较敏感。结论新生儿VAP的病原菌分布和耐药性均具有一定的特征,应根据监测结果选用敏感抗菌药物进行治疗,以避免加重病原菌耐药,提高治愈率。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing ventilator-associated pneumonia（VAP）in neonates so as to provide objective evidence for development of reasonable anti-infection programs.METHODS A total of 60 neonates with VAP who were hospitalized in the neonatal intensive care unit（NICU）from Jan 2013 to Dec 2014 were recruited as the study objects,then the sputum specimens were collected for bacterial culture,the pathogens were identified by using automatic microorganism identification system,the drug susceptibility testing was performed by means of K-B disk diffusion method,and the results of the drug susceptibility testing were statistically analyzed with the use of WHONET 5.3software.RESULTS Totally 45 strains of pathogens were isolated from the submitted specimens that were obtained from the 60 neonates with VAP,with the positive detection rate of 75.0%.All of the isolated pathogens were gram-negative bacteria,of which 31.1%were Klebsiella pneumoniae,28.9% were Escherichia coli,and 20.0% were Acinetobacter baumannii.The three species of pathogens were highly resistant to the commonly used antibiotics;the drug resistance rates of the K.pneumoniae and E.coli to most of cephalosporins were 100.0%,and the strains were highly susceptible to ciprofloxacin and amikacin.CONCLUSIONBoth the distribution and drug resistance of the pathogens isolated from the neonates with VAP show certain characteristics.It is necessary to reasonably use antibiotics on the basis of the results of the drug susceptibility testing so as to avoid the increase of the drug resistance and raise the cure rate.