584例新生儿感染性肺炎病原菌分布及耐药性分析
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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β-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。
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 to2016.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.
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 to2016.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.
引文
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[10]葛昌玲,李英杰,成少华.683例新生儿感染性肺炎病原菌分布及药敏结果分析[J].儿科药学杂志,2014,20(3):38-40.
[11]BRZYCHCZY-WLOCH M,WOJKOWSKA-MACH J,HELWICH E,et al.Incidence of maternal GBS colonization and neonatal GBS disease among very low birth weight Polish neonates[J].Med Sci Monit,2013,19:34-39.
[12]赖春华,张晓敏,王维琼,等.新生儿肺炎痰细菌培养及药敏148例分析[J].长治医学院学报,2010,24(2):118-120.
[13]汪复.产β-内酰胺酶耐药菌感染的防治策略[J].中华传染病杂志,2000,18(3):149-150.
[2]陈新,周林,钟威达.儿童细菌性肺炎的病原菌及其耐药状况分析[J/OL].中华妇幼临床医学杂志:电子版,2012,8(2):199-202.
[3]朱林敏,陈彦香,陈少峰.新生儿肺炎病原菌分布及细菌耐药分析[J].宁夏医学杂志,2014,36(2):136-138.
[4]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].第4版.北京:人民卫生出版社,2011:401-405.
[5]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[M].18th Wayne,2008:28.
[6]吕奎琳,王丽雁,廖伟,等.新生儿感染性肺炎病因学检测及细菌药敏分析[J].重庆医学,2012,41(1):33-35.
[7]陈梅,姜利军,郑芳.新生儿肺炎病原菌分布及耐药性分析[J].中华医院感染学杂志,2014,24(5):1276-1278.
[8]张慧,刘海霞,肖金.我院住院肺炎患儿病原菌及药敏试验结果分析[J].儿科药学杂志,2011,17(5):42-44.
[9]黄勇,陈秉孟,邓秋连,等.广州儿童医院重症监护病房感染病原菌的分布及耐药性分析[J].中国微生态学杂志,2006,18(3):219-221.
[10]葛昌玲,李英杰,成少华.683例新生儿感染性肺炎病原菌分布及药敏结果分析[J].儿科药学杂志,2014,20(3):38-40.
[11]BRZYCHCZY-WLOCH M,WOJKOWSKA-MACH J,HELWICH E,et al.Incidence of maternal GBS colonization and neonatal GBS disease among very low birth weight Polish neonates[J].Med Sci Monit,2013,19:34-39.
[12]赖春华,张晓敏,王维琼,等.新生儿肺炎痰细菌培养及药敏148例分析[J].长治医学院学报,2010,24(2):118-120.
[13]汪复.产β-内酰胺酶耐药菌感染的防治策略[J].中华传染病杂志,2000,18(3):149-150.