2014-2017年某院NICU新生儿感染性肺炎病原菌分布及耐药性变迁
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摘要
目的探讨某医院新生儿肺炎病原菌分布及细菌耐药性变迁,指导临床合理选用抗菌药物。方法回顾性分析新生儿肺炎痰培养阳性及药敏试验结果。结果 4年共收集1340份检测标本,分离出26种常见病原菌457株,阳性分离率为34.1%,其中G+菌115株、G-菌342株,分别占分离菌株的25.2%和74.8%。各年的细菌构成变化不大。前5位分离出的细菌依次是大肠埃希菌(26.7%)、肺炎克雷伯杆菌(20.3%)、金黄色葡萄球菌(11.6%)、阴沟肠杆菌(9.6%)和表皮葡萄球菌(8.3%)。主要G-菌对抗菌药物耐药性呈波动性变化,其中大肠埃希菌及肺炎克雷伯杆菌的耐药率有上升趋势,总体对氨苄西林耐药率高,对头孢他啶、β内酰胺类、阿米卡星、碳青霉烯类敏感性较高。已出现了耐碳青霉烯类的肺炎克雷伯杆菌及阴沟肠杆菌。革兰氏阳性菌以金黄色葡萄球菌为主,各年的耐药率无明显差异,未发现对万古霉素及替考拉宁耐药的菌株。结论某院新生儿肺炎常见的致病菌以G-菌(大肠埃希菌及肺炎克雷伯杆菌)为主,不同类型的病原菌对抗菌药物的敏感性不同,且已分离出耐碳青霉烯类的肠杆菌,临床应根据药敏检测结果合理选择抗菌药物。
Objective To investigate the distribution characteristics of the pathogenic microorganism and tendency of antibiotic resistance of neonatal pneumonia at NICU in our hospital,in order to clarity the characteristics of pathogens and to guide clinical rational selection of antibiotics.Methods The bacterial culture and drug sensitivity of sputum samples in our hospital were analyzed retrospectively.Results 1 340 samples for testing were collected,and a total of 26 kinds 457 pathogenic bacterial strains were isolated,positive isolation rate being 34.1%,including 115(25.2%) Gram-positive bacteria and 342(74.8%) Gram-negative bacteria.The composition of main bacteria in each year had little change.The first five pathogenic bacteria were Escherichia coli(26.7%),Klebsiella pneumonia(20.3%),Staphylococcus aureus(11.6%),Enterobacter cloacae(9.6%),Staphylococcus epidermidis(8.3%).The drug resistance rate of the main leather gram-negative bacteria to commonly used antibiotic fluctuated,the drug resistance of Escherichia coli and Klebsiella pneumoniae were in a rising trend.Overall,gram-negative bacteria were highly resistant to ampicillin and highly sensitive to ceftazidime,beta-lactase,amikacin and carbapenems.Carbapenem-resistant Klebsiella pneumoniae and Enterobacter cloacae was found.The main gram-positive bacteria were Staphylococcus aureus and the resistant rate did not change during 4 years.No resistance to vacocin vancomycin and teicoplanin was found.Conclusion Gram-negative bacilli predominates the pathogens of lower respiratory tract infection in neonates,especially Escherichia coli and Klebsiella pneumoniae.Different bacteria show different drug resistances.Carbapenem-resistant Enterobacteriaceae has been found.
Objective To investigate the distribution characteristics of the pathogenic microorganism and tendency of antibiotic resistance of neonatal pneumonia at NICU in our hospital,in order to clarity the characteristics of pathogens and to guide clinical rational selection of antibiotics.Methods The bacterial culture and drug sensitivity of sputum samples in our hospital were analyzed retrospectively.Results 1 340 samples for testing were collected,and a total of 26 kinds 457 pathogenic bacterial strains were isolated,positive isolation rate being 34.1%,including 115(25.2%) Gram-positive bacteria and 342(74.8%) Gram-negative bacteria.The composition of main bacteria in each year had little change.The first five pathogenic bacteria were Escherichia coli(26.7%),Klebsiella pneumonia(20.3%),Staphylococcus aureus(11.6%),Enterobacter cloacae(9.6%),Staphylococcus epidermidis(8.3%).The drug resistance rate of the main leather gram-negative bacteria to commonly used antibiotic fluctuated,the drug resistance of Escherichia coli and Klebsiella pneumoniae were in a rising trend.Overall,gram-negative bacteria were highly resistant to ampicillin and highly sensitive to ceftazidime,beta-lactase,amikacin and carbapenems.Carbapenem-resistant Klebsiella pneumoniae and Enterobacter cloacae was found.The main gram-positive bacteria were Staphylococcus aureus and the resistant rate did not change during 4 years.No resistance to vacocin vancomycin and teicoplanin was found.Conclusion Gram-negative bacilli predominates the pathogens of lower respiratory tract infection in neonates,especially Escherichia coli and Klebsiella pneumoniae.Different bacteria show different drug resistances.Carbapenem-resistant Enterobacteriaceae has been found.
引文
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[15]洪辉波,陈萍花,郭少君,等.2006~2008年医院感染临床病原菌分布及其耐药性调查分析[J].中华医院感染学杂志,2010,20(6):863-865.
[16]王丽青,金志彪,周茶香.NICU新生儿感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(1):81-82,96.
[17]王燕英.新生儿重症监护病房患儿细菌感染分布和耐药性分析[J].中外医学研究,2013,11(7):54-55.
[18]章小芳,叶丽娟.院内感染新生儿肺炎病原菌分布特点及干预对策[J].中国微生态学杂志,2014,26(2):188-191.
[19]Tan B,Xian-Yang X,Zhang X,et al.Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units:a meta-analysis[J].American Journal of Infection Control,2014,42(8):902-910.
[20]Biran V,Gaudin A,Marian-Kurdijian P,et al.Implication of extended-spectrum betalactamase enterobacteriaceae in nosocomial infections in neonates[J].Archives de Pediatrie:Organe Officiel de La Societe Francaise de Pediatrie,2010,17(s14):150-153.
[21]陈鸿羽,李媛媛,邓春.2010至2014年我院新生儿肺炎主要病原菌分布及耐药性变迁[J].重庆医科大学学报,2017,42(1):42-49.
[22]周丽银,徐建民,张微惠.新生儿呼吸道感染病原菌分布及耐药性情况[J].实验与检验医学,2018,36(1):67-69.
[23]侯齐书,叶继锋,林小君.382例新生儿肺炎病原菌分布及耐药性分析[J].中国消毒学杂志,2018,35(7):548-550.
[24]展冠军,缪玉山,詹莹,等.大肠埃希菌耐药性与抗菌药物使用量的相关性分析[J].中国全科医学,2013,16(5):456-458,461.
[25]吕奎林,王丽雁,廖伟,等.新生儿感染性肺炎病原学检测及细菌药敏分析[J].重庆医学,2012,41(1):33-35.
[2]邵肖梅,叶泓瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011:401-405.
[3]常媛媛,周闯,石小湘.新生儿社区获得性肺炎病原菌及药物敏感分析[J].新疆医学,2012,42(7):17-19.
[4]高萍萍,严菊英.新生儿社区获得性肺炎病原菌分布及药敏分析[J].中华医院感染学杂志,2012,22(6):1293-1295.
[5]艾健娜,李海芹,石瑞琪.新生儿社区获得性肺炎病原菌分布特点和药敏分析[J].河北联合大学学报:医学版,2013,15(3):319-320.
[6]朱林敏,陈彦香,陈少峰,等.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.
[7]王海娟,石华,周伟,等.新生儿肺炎常见病原体及临床特征分析[J].中国当代儿科杂志,2012,14(12):898-902.
[8]卓少宏,伍成峰,马兴灶,等.新生儿感染性肺炎的病原菌状况分析[J].中国微生态学杂志,2012,24(7):638-639,642.
[9]魏克伦.我国新生儿感染现状与展望[J].中国实用儿科杂志,2011,26(1):1-2.
[10]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/CD].中华妇幼临床医学杂志:电子版,2012,8(2):199-202.
[11]刘长喜,李先斌.4230例新生儿感染性肺炎病原菌的分布及耐药分析[J].实用预防医学,2010,17(1):142-144.
[12]石翎雁,王晓红,王新平.新生儿死亡情况评审资料分析[J].中国妇幼保健,2012,27(20):3131-3132.
[13]赵翠香,雷银香,李平洁.新生儿死亡原因分析及干预措施[J].现代中西医结合杂志,2012,21(2):179.
[14]崔黎红,郑志辉,郎丹丹,等.新生儿医院感染细菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(7):1660-1662.
[15]洪辉波,陈萍花,郭少君,等.2006~2008年医院感染临床病原菌分布及其耐药性调查分析[J].中华医院感染学杂志,2010,20(6):863-865.
[16]王丽青,金志彪,周茶香.NICU新生儿感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(1):81-82,96.
[17]王燕英.新生儿重症监护病房患儿细菌感染分布和耐药性分析[J].中外医学研究,2013,11(7):54-55.
[18]章小芳,叶丽娟.院内感染新生儿肺炎病原菌分布特点及干预对策[J].中国微生态学杂志,2014,26(2):188-191.
[19]Tan B,Xian-Yang X,Zhang X,et al.Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units:a meta-analysis[J].American Journal of Infection Control,2014,42(8):902-910.
[20]Biran V,Gaudin A,Marian-Kurdijian P,et al.Implication of extended-spectrum betalactamase enterobacteriaceae in nosocomial infections in neonates[J].Archives de Pediatrie:Organe Officiel de La Societe Francaise de Pediatrie,2010,17(s14):150-153.
[21]陈鸿羽,李媛媛,邓春.2010至2014年我院新生儿肺炎主要病原菌分布及耐药性变迁[J].重庆医科大学学报,2017,42(1):42-49.
[22]周丽银,徐建民,张微惠.新生儿呼吸道感染病原菌分布及耐药性情况[J].实验与检验医学,2018,36(1):67-69.
[23]侯齐书,叶继锋,林小君.382例新生儿肺炎病原菌分布及耐药性分析[J].中国消毒学杂志,2018,35(7):548-550.
[24]展冠军,缪玉山,詹莹,等.大肠埃希菌耐药性与抗菌药物使用量的相关性分析[J].中国全科医学,2013,16(5):456-458,461.
[25]吕奎林,王丽雁,廖伟,等.新生儿感染性肺炎病原学检测及细菌药敏分析[J].重庆医学,2012,41(1):33-35.