| 摘要: |
| 目的:探讨新生儿感染性肺炎病原菌分布特点及其耐药性,以指导临床用药。方法:回顾性分析2015-2016年收治的390例社区获得性肺炎(CAP)和194例医院感染性肺炎(HAP)新生儿病原菌检测结果及药敏试验结果。结果:584例患儿送检标本共382例培养阳性,阳性率为65.4%;分离致病菌411株,其中革兰阴性菌(G-菌)288株,革兰阳性菌(G+菌)118株,真菌5株;G-菌以大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌为主,G+以金黄色葡萄球菌、表皮葡萄球菌、草绿色链球菌为主。CAP患儿送检标本检出致病菌181株,其中G-菌119株(65.8%),以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主;G+菌59株(32.6%),以金黄色葡萄球菌、表皮葡萄球菌为主;真菌3株(1.7%);194例HAP患儿送检标本检出致病菌230株,其中G-菌169株(73.5%),以鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌为主;G+菌59株(25.7%),以草绿色链球菌、表皮葡萄球菌、金黄色葡萄球菌为主;真菌2株(0.9%)。G-对青霉素类及头孢菌素类抗菌药物耐药率较高,对亚胺培南、环丙沙星、呋喃妥因敏感;G+菌对青霉素类、环丙沙星、左氧氟沙星、庆大霉素等高度耐药,对阿米卡星、万古霉素、替考拉宁、利奈唑胺、奎奴普丁等敏感。CAP及HAP常见致病菌对临床常用抗菌药物的耐药性差异不明显。本组共检出产超广谱茁鄄内酰胺酶(ESBL)大肠埃希菌34株,占大肠埃希菌总检出株数的34.3%;产ESBL肺炎克雷伯菌24株,占肺炎克雷伯菌总检出株数的34.3%。结论:本地区
新生儿感染性肺炎的病原菌以G-为主,大肠埃希菌、金黄色葡萄球菌为常见致病菌。加强细菌耐药性监测,指导临床合理使用抗菌药物,可减缓耐药菌株的产生。 |
| 关键词: 肺炎 新生儿 病原菌 耐药性 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.09.014 |
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| 基金项目: |
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| Distribution and Drug Resistance of 584 Cases of Neonatal Infectious Pneumonia |
| Liu Yawen1, Yang Xiyong2, Zhao Xiaoyan2, Wang Zhen2, Zheng Ximing2 |
| (1. Zhumadian Traditional Chinese Medicine Hospital, Henan Zhumadian 463000, China; 2. Zhumadian Central Hospital, Henan Zhumadian 463000, China) |
| Abstract: |
| Objective: To investigate the distribution characteristics and drug resistance of neonatal infectious pneumonia, so as to guide clinical medication. Methods: Retrospective analysis was conducted on results of pathogen detection and drug sensitivity test of 390 children with community-acquired pneumonia (CAP) and 194 children with hospital-acquired pneumonia (HAP) admitted from 2015 to 2016. Results: Of the 584 samples, 382 cases were positive, with the positive rate of 65. 4%. Four hundreds and eleven strains of pathogenic bacteria were isolated, including 288 gram-negative bacteria (G- bacteria), 118 gram-positive bacteria (G+ bacteria) and 5 fungi strains. G-bacteria were mainly Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii, G+ bacteria were mainly Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus viridans. One hundred and eighty-one strains of pathogenic bacteria were detected from children with CAP , including 119 strains (65.8%) of G- bacteria, mainly Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa; 59 strains of G+ bacteria (32.6%) were detected, mainly Staphylococcus aureus and Staphylococcus epidermidis; with 3 strains of fungi (1.7%). A total of 230 pathogenic bacteria were detected in 194 children with HAP, including 169 strains (73.5%) of G- bacteria, mainly Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli; 59 strains of G+ bacteria (25.65%) were detected, mainly Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus aureus; with 2 strains of fungi (0.9%). Gbactevia were highly resistant to penicillins and cephalosporins, and sensitive to imipenem, ciprofloxacin and nitrofurantoin; and G+ bacteria were highly resistant to penicillins, ciprofloxacin, levofloxacin, gentamicin, and sensitive to amikacin, vancomycin, teicoplanin, linezolid and quinupristin. There was no significant difference in the resistance of CAP and HAP common pathogens to clinically used antibiotics. In this group, 34 strains of extended-spectrum β-lactamase (ESBL) Escherichia coli were detected, accounting for 34.3% of the total number of Escherichia coli strains; 24 strains of ESBLs-producing Klebsiella pneumoniae were detected, accounting for 34.3% of the total number of Klebsiella pneumoniae isolates. Conclusion: The pathogens of neonatal infectious pneumonia in this area are mainly Gbactevia, Escherichia coli and golden yellow grape are common pathogens. Strength of the monitoring of bacterial resistance and guidance of the rational use of antibiotics in clinical practice can slow the production of drug-resistant strains. |
| Key words: pneumonia neonatal pathogen drug resistance |
