NICU下呼吸道标本分离的革兰阴性菌分布及耐药性分析

Distribution and drug resistance of gram-negative bacteria isolated from lower respiratory tract specimens of NICU

目的了解新生儿重症监护室(NICU)患儿下呼吸道分离的革兰阴性菌分布特征及耐药性,为临床合理用药提供实验室依据。方法收集2016年1月至2018年12月自该院新生儿科送检标本分离出的革兰阴性菌,采用VITEK 2 Compact全自动微生物鉴定系统及纸片扩散法进行药敏试验。采用WHONET5.6软件对细菌的药敏结果进行统计分析。结果本研究分离出1 668株革兰阴性菌,肺炎克雷伯菌760株(45.6%)居第一位,其次为大肠埃希菌357株(21.4%)、鲍曼不动杆菌118株(7.1%)、阴沟肠杆菌113株(6.8%)、流感嗜血杆菌105株(6.3%)。肺炎克雷伯菌对氨基糖苷类、喹诺酮类、碳青霉烯类、头霉素类药物以及复方磺胺甲噁唑的耐药率低<22.4%;大肠埃希菌对氨基糖苷类、喹诺酮类、碳青霉烯类、头霉素类、四代头孢菌素类药物以及头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶的耐药率低<25.2%;阴沟肠杆菌对所测抗菌药物灵敏度均较好,除头孢呋辛(60.4%)外其余抗菌药物耐药率<27.4%;鲍曼不动杆菌除对头孢替坦耐药率高(98.3%),对其余所测抗菌药物耐药率低<14.4%。结论该院新生儿科下呼吸道分离革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、阴沟肠杆菌、流感嗜血杆菌为主。碳青霉烯类、氨基糖苷类、喹诺酮类抗菌药物对主要革兰阴性菌(肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌)耐药率低。

Objective To understand the distribution and drug resistance of gram-negative bacteria isolated from lower respiratory tract of neonates in neonatal intensive care unit(NICU),and to provide laboratory evidence for rational drug use in clinic.Methods Gram-negative bacteria isolated from samples sent to the neonatal department of our hospital from January 2016 to December 2018 were collected and tested by VITEK 2 compact automatic microbial identification system and disk diffusion method.WHONET 5.6 software was used to analyze the results of bacterial susceptibility.Results A total of 1 668 strains of Gram-negative bacteria were isolated from the study,760 strains of klebsiella pneumoniae(45.6%)ranked first,followed by escherichia coli 357(21.4%),bauman acinetobacter 118(7.1%),enterobacter cloacae 113(6.8%),and haemophilus influenzae 105(6.3%).The drug resistance rates of klebsiella pneumoniae to aminoglycosides,quinolones,carbapenems,cephalosporins and compound neotamine were lower than 22.4%.The drug resistance rates of escherichia coli to aminoglycosides,quinolones,carbapenems,cephalosporins,fourth-generation cephalosporins and cefoperazone/sulbactam,piperacillin/tazobactam and ceftazidime were lower than 25.2%.The sensitivity of Enterobacteriaceae to antimicrobial agents was good,except for cefuroxime(60.4%),the resistance rate of other antibiotics was<27.4%.Acinetobacter was higher than that of cefotam resistant(98.3%),and the resistance rate to other antibiotics was<14.4%.Conclusion Gram negative bacteria isolated from lower respiratory tract of neonatal department are mainly klebsiella pneumoniae,escherichia coli,acinetobacter bauman,enterobacter cloacae and haemophilus influenzae.Carbapenems,aminoglycosides and quinolones are less resistant to gram-negative bacteria(klebsiella pneumoniae,escherichia coli and enterobacter cloacae).