NICU中新生儿败血症及呼吸机相关肺炎的病原菌及耐药性分析
Analysis of the pathogenic bacteria and its drug resistance in neonatal sepsis and ventilator associated pneumonia in NICU
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摘要: 目的：分析NICU中新生儿败血症及呼吸机相关性肺炎（VAP）的病原菌特点及耐药情况，为临床选择抗生素提供参考依据。方法：回顾性分析97例新生儿败血症患儿的血培养和药物敏感性（药敏）结果，40例VAP患儿的痰培养和药敏结果。结果：血培养共检出病原菌97株，革兰阳性球菌主要为表皮葡萄球菌、溶血性葡萄球菌和人葡萄球菌，对青霉素、红霉素和苯唑西林高度耐药，对利奈唑胺和万古霉素也有个别耐药；革兰阴性杆菌为肺炎克雷伯菌和大肠埃希菌，对氨苄西林、氨曲南、头孢唑啉、头孢曲松和头孢他啶高度耐药。痰培养共检出病原菌41例（其中1例患儿同时有细菌和真菌感染），其中革兰阴性杆菌39例，主要为鲍曼不动杆菌、黏质沙雷菌、嗜麦芽窄食单胞菌和肺炎克雷伯菌，均为多重耐药。痰培养检出真菌均为白色念珠菌。结论：血培养结果提示新生儿败血症多为葡萄球菌感染，VAP痰培养多为革兰阴性杆菌感染，应根据其检测结果合理使用抗生素，提高疗效，减少细菌耐药性。Abstract: Objective: To analyze the pathogenic bacteria characteristics and its drug resistance in neonatal sepsis and ventilator associated pneumonia(VAP) in NICU,and provide the evidence in selecting antibiotics.Methods: The data of blood culture and drug susceptibility in 97 neonatal sepsis patients were retrospectively analyzed.Results: Ninety-seven pathogenic bacteria strains were detected in blood culture.In blood culture,the gram positive bacteria mostly included staphylococcus epidermidis,staphylococcus haemolyticusand staphylococcus hominis,which was highly resistant to penicillin,erythromycin and oxacillin,and individually resistant to linezolid and vancomycin.In blood culture,the gram-negative bacteria mostly included klebsiella pneumoniae and escherichia Coli,which was highly resistant to ampicillin,aztreonam,cefazolin,ceftriaxone and ceftazidime.Forty-two pathogenic bacteria strains were detected in sputum culture(including 1 case with bacterial complicated with fungal infection),In sputum culture,thirty-nine gram negative bacteria were detected,which mainly included acinetobacter bauman,serratia marcescens,stenotrophomonas maltophilia and klebsiella pneumonia,and was multi drug resistant bacteria.The fungi detected by sputum culture was candida albicans.Conclusions: Blood culture result shows that the staphylococcus is main infection in neonatal sepsis,the sputum culture result in ventilator associated pneumonia patient shows that the gram-negative bacilli is main infection.The antibiotics should be reasonably applied according to the test result,which can improve the efficacy and reduce the resistance of bacteria.
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