新生儿重症监护病房呼吸机相关性肺炎病原菌分布及耐药性分析

摘要

Objective To investigate the distribution and drug resistance of pathogenic bacteria of ventila-tor-associated pneumonia(VAP)in neonatal intensive care unit.Methods A total of 100 cases of VAP pa-tients in NICU of the hospital were selected,sampling the sputum suction tube by tracheal intubation for low-er respiratory tract sputum specimens for bacterial identification,pathogenic bacteria identification and drug sensitive test were conducted,and drug sensitivity test results were compared and analyzed.Results The de-tection rate of gram negative bacteria(Escherichia coli,Klebsiella pneumoniae,Acinetobacter Bauman,et al) were 86.00%,which was significantly higher than those of gram positive bacteria(Staphylococcus aureus, Staphylococcus haemolyticus,et al.)account for 14.00%,the difference was statistically significant(P<0.05).The rate of gram negative bacterias such as Escherichia coli,Bauman Acinetobacter,Klebsiella pneu-moniae resistant to ceftazidime,cefazolin and ceftriaxone were significantly higher than Amikacin and imipen-em,the difference was statistically significant(P< 0.05).Conclusion VAP pathogens are usually consist of Gram-negative bacterias including Escherichia coli,Klebsiella pneumoniae and Bauman Acinetobacter,cephalo-sporins is the first choice of empiric therapy,but the drug resistance is strong,w hile the drug resistance to Amikacin and imipenem are at a low level yet.It′s important for guiding clinical rational use of drugs by regu-lar monitoring of NICU in VAP pathogen bacteria and antibiotic resistance.%目的 探究新生儿重症监护病房(NICU)呼吸机相关性肺炎(VAP)病原菌分布及耐药性情况.方法 选取该院NICU收治的100例VA P患儿,吸痰管经气管插管来收取下呼吸道痰液标本进行细菌鉴定,采用全自动鉴定仪、药敏分析仪鉴定菌种及药敏试验,并对药敏试验结果进行对比分析.结果 革兰阴性杆菌(大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌等)检出的比例(86.00%)明显高于革兰阳性球菌(金黄色葡萄球菌、溶血性葡萄球菌等)的比例(14.00%),差异有统计学意义(P<0.05).大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌等革兰阴性杆菌致病菌对头孢他啶、头孢唑啉、头孢曲松耐药率明显高于阿米卡星、亚胺培南类耐药率,差异有统计学意义(P<0.05).结论 VA P病原菌以革兰阴性杆菌为主,大肠埃希菌、肺炎克雷伯菌及鲍曼不动杆菌较常见,头孢类药物为首选经验性用药,存在明显耐药性,但致病菌对阿米卡星、亚胺培南类药物耐药性较低,定期监测NICU患儿VAP病原菌分布及其耐药性变迁情况,对指导临床合理用药有重要作用.