2010至2014年我院新生儿肺炎主要病原菌分布及耐药性变迁

Distribution and antibiotic resistance of pathogens in neonatal pneumonia in our hospital from 2010 to 2014

目的:探讨我院2010年1月至2014年12月新生儿肺炎的病原菌分布及耐药性变迁,明确本地区病原菌特点,指导临床合理选药。方法:回顾性分析我院2010年1月至2014年12月新生儿痰标本细菌培养及药敏结果。结果:5年共检出病原菌4 310株,其中革兰阴性菌3 722株(86.4%),革兰阳性菌556株(12.9%),真菌32株(0.7%);产ESBLs菌1061株(32.2%),MRSA 37株(7.9%)。各年主要细菌构成变化不大,依次为肺炎克雷伯菌(1216株,28.2%)、大肠埃希菌(859株,19.9%)、金黄色葡萄球菌(469株,10.9%)、阴沟肠杆菌(435株,10.1%)及鲍曼不动杆菌(432株,10.0%);各年产酶率略有变化,而MRSA检出率比较无差异。主要革兰阴性菌对常用抗菌药物的耐药性呈波动性变化,其中肺炎克雷伯菌和大肠埃希菌的耐药性有下降趋势;总体对大部分β-内酰胺酶类高度耐药,对阿米卡星、碳青霉烯类高度敏感。金黄色葡萄球菌各年的耐药率无差异,未发现耐糖肽类及利奈唑胺的菌株。结论:新生儿肺炎的主要病原菌为革兰阴性菌(尤其是肺炎克雷伯菌和大肠埃希菌),因时间差异,细菌对不同抗菌药物的耐药性不同。虽近5年各主要病原菌的耐药性呈下降趋势,但产ESBLs检出率仍较高,且已分离出耐碳青霉烯类的肠杆菌。

Objective：To investigate the distribution of pathogens and antibiotic resistance of neonatal pneumonia in our hospital,to clarify the characteristics of pathogens and to guide clinical rational drug selection. Methods：The bacterial culture and drug sensitivity of sputum samples from 2010 to 2014 in our hospital were analyzed retrospectively. Results：A total of 4 310 pathogenic isolates were detected in 5 years;3 722 stranis（86.4%） were gram-negative bacilli,556 strains（12.9%） were gram-positive bacilli,32 strains（0.7%）were fungi. There were 1 061 strains（32.3%）of extended spectrum beta-lactamases（ESBL）-producing bacteria,37 strains（7.9%）of methicillin-resistant staphylococcus aureus（MRSA）. The composition of main bacteria in each year had little change：Klebsiella pneumoniae（1 216 strains,28.2%）,Escherichia coli（859 strains,19.9%）,Staphylococcus aureus（469 strains,10.9%）,Enterobacter cloacae（435 strains,10.1%） and Acinetobacter baumannii（432 strains,10.0%）. The rate of enzyme production in each year changed in volatility,while the detection rate of MRSA had no significant difference. The drug resistance rate of the main leather gram-negative bacteria to commonly used antibiotic fluctuated;the drug resistance rate of Klebsiella pneumoniae and Escherichia coli was in a downward trend;overally,gram-negative bacteria were highly resistant to most of the beta-lactase and highly sensitive to amikacin and carbapenems. The resistant rate of Staphylococcus aureus did not change during five years;no resistance to glycopeptides and linezolid was found. Conclusion：The main pathogens of neonatal pneumonia are gram-negative bacteria,especially Klebsiella pneumoniae and Escherichia coli. Bacteria show different drug resistances because of time difference. Although drug resistance rate of the main pathogenic bacteria is in downward trend in recent 5 years,the rate of ESBL-producing is still high,and carbapenem-resistant Enterobacteriaceae has been found.