摘要
目的探讨新生儿重症监护室(NICU)中呼吸窘迫综合征(RDS)晚期早产儿呼吸机相关肺炎(VAP)临床病原学特点及细菌耐药性,为抗生素选择提供依据。方法收集2013年1月—2015年12月我院NICU收治的并发VAP的RDS晚期早产儿38例,所有病儿均行气管内分泌物培养和药物敏感试验。结果 38例行痰培养,30例细菌培养阳性,阳性率为78.95%。共培养出病原菌40株,其中革兰阳性菌3株(7.5%),革兰阴性菌37株(92.5%),肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌是3种主要致病菌。肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株12株,占60%,且产ESBLs菌株较非产ESBLs菌株耐药性高。铜绿假单胞菌及鲍氏不动杆菌未检出产ESBLs菌株。3种主要致病菌均对头孢类抗生素有较高耐药性,对亚胺培南、哌拉西林他唑巴坦及环丙沙星敏感。结论 RDS晚期早产儿VAP的主要致病菌为革兰阴性菌,且对临床常用抗生素广泛耐药。
Objective To instigate the distribution and drug resistance of pathogenic bacteria of ventilator-associated pneumonia （VAP） in late preterm infants with respiratory distress syndrome （RDS） in neonatal intensive care unit （NICU）, and to provide a reference for antibiotic selection. Methods A retrospective analysis was performed in 38 late preterm infants with RDS who developed VAP during mechanical ventilation in the NICU of Qlngdao Women and Children Hospital from January 2013 to De- cember 2015. The tracheal secretion culture and drug sensitivity test were performed in all patients. Results Of all the 38 patients, 30 （78.95%） had a positive bacterial culture. A total of 40 strains of pathogenic bacteria were isolated, including 3 Gram- positive strains （7.5 %） and 37 Gram-negative strains （92.5% ）. Klebsiella pneurnoniae, Pseudomonas aeruginosa, and Acineto- bacter baumannii were the three main pathogenic bacteria. There were 12 strains of extended spectrum β-lactamases （ESBLs）-pro- ducing Klebsiella pneumoniae （60%） and the ESBLs-producing strains had a higher drug resistance than the non-ESBLs-producing strains. There were no ESBLs-producing Pseudomonas aeruginosa and Acinetobacter baurnannii. The three main pathogenic bacte- ria had a high resistance to cephalosporins and were sensitive to imipenem, piperacillin-tazobactam, and ciprofloxacin. Conclusion Gram-negative bacteria are main pathogenic bacteria of VAP in late preterm infants with RDS and they are extensively resistant to common antibiotics.
出处
《齐鲁医学杂志》
2017年第2期217-219,223,共4页
Medical Journal of Qilu
关键词
婴儿
早产
呼吸窘迫综合征
新生儿
肺炎
呼吸机相关性
病原
微生物敏感性试验
infant,premature
respiratory distress syndrome, newborn
pneumonia, ventilator-associated
noxae
mi- crobial sensitivity tests
