早产儿肺炎242例病原学及临床特征分析

Common pathogens and clinical characteristics of 242 cases of the preterm infants with pneumonia

目的探讨早产儿肺炎的病原分布及耐药情况,分析患儿临床特征,指导临床合理用药。方法选取郑州大学第三附属医院2014年1月至2018年6月收治的痰培养阳性的242例早产儿肺炎患者,收集其相关病原学及临床资料。结果242例早产儿肺炎患者共检出437株病原菌,其中革兰阴性菌407株,革兰阳性菌22株,真菌8株。肺炎克雷伯菌(235株)、大肠埃希菌(44株)、鲍曼不动杆菌(42株)及铜绿假单胞菌(31株)为早产儿肺炎最常见的病原体。克雷伯菌及不动杆菌属对广谱青霉素类、头孢菌素类、含β-内酰胺酶抑制剂等抗生素耐药率均较高。出生体质量<1000g、肺出血、机械通气≥14d等为早产儿肺炎预后不良的独立危险因素(P<0.05)。结论早产儿肺炎病原菌以革兰阴性菌为主,特别是肺炎克雷伯菌,病原菌对多种抗生素较高的耐药率应引起高度重视。超低出生体质量、合并肺出血或机械通气时间较长且罹患肺炎的早产儿可能预后不良,应提高警惕。

Objective To study the common pathogens and their antibiotic susceptibility as well as clinical characteristics of the preterm infants with pneumonia, and provide guidance for the rational use of antimicrobial agents. Methods A total of 242 cases of pneumonia of premature infants with positive sputum culture admitted to the Third Affiliated Hospital of Zhengzhou University from January 2014 to June 2018 were selected. Results A total of 437 strains of pathogenic bacteria were detected, including 407 strains of Gram-negative bacteria, 22 strains of Gram-positive bacteria and 8 strains of fungus. Klebsiella pneumonia, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa were the main pathogens.Klebsiella and Acinetobacter were highly resistant to penicillins, cephaloporins and β-lactams.The logistic regression analysis showed that birth weight <1 000 g, pneumorrhagia and duration of mechanical ventilation ≥14 d were risk factors of the unfavourable prognosis. Conclusions Gram-negative bacteria, especially Klebsiella pneumonia are predominant pathogens of neonatal pneumonia.We need to attach great importance to the highly resistant to antibiotics. Low birth weight, pneumorrhagia and mechanical ventilation required at 2 weeks after birth are risk factors of the poor prognosis which should arise our attention.