摘要
目的:了解新生儿重症监护病房(NICU)呼吸机相关肺炎(VAP)病原菌分布及其耐药性发展趋势,为临床抗菌药物合理使用提供参考依据。方法:通过前瞻性目标监测,对2015-01—2017-12期间入住NICU实施机械通气治疗的患儿发生VAP病原菌进行监测和药敏试验结果分析。结果:纳入监测的884例患儿中,发生VAP116例,发生率为13.12%;共分离病原菌120株,其中革兰阴性杆菌106株(88.33%),革兰阳性球菌8株(6.67%),真菌6株(5.00%);检出致病菌居前3位分别为鲍曼不动杆菌(49.17%)、肺炎克雷伯菌(22.50%)和铜绿假单胞菌(8.33%)。鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌对亚胺培南和美洛培南的耐药率分别是96.61%、18.52%和40.00%;凝固酶阴性葡萄球菌均为甲氧西林耐药株。结论:建立多重耐药预警监测机制,及时掌握NICU呼吸机相关肺炎病原菌的临床分布及耐药特点,合理使用抗菌药物,减少耐药菌的产生。
Objective：To understand the distribution of pathogenic bacteria and the development trend of drug resistance in neonatal intensive care unit（NICU）ventilator associated pneumonia（VAP）,providing a reference for the rational use of antibacterial drugs.Method：Through prospective target monitoring,the results of monitoring and drug sensitivity test were analyzed for the patients who were admitted to NICU from January 2015 to December 2017 for the implementation of mechanical ventilation treatment.Result：Among 884 cases of monitoring newborn,116 had VAP,with the morbidity rate 13.12%;A total of 120 strains of pathogens were isolated,gram-negative bacteria for 88.33%（106/120）,gram-positive bacteria 6.67%（8/120）,and fungi 5.00%（6/120）.The top three pathogens were Acinetobacterbaumannii（49.17%）、klebsiellapneumoniae（22.50%）and Pseudomonas aeruginosa（8.33%）.Antimicrobial resistance rates of Acinetobacterbaumannii、klebsiellapneumoniae and Pseudomonas aeruginosa to imipenem and meropenem were 96.61%、18.52% and 40.00% respectively;coagulase negative staphylococcus are all methicillin-resistant.Conclusion：Establishment of multi-drug resistance warning monitoring mechanism,it is necessary to understand the distribution and antobiotic resistance of the Ventilator Associated Pneumonia in NICU for better control and prevention of such infections,which promotes rational use of antimicrobial agents,reduces the production of resistant bacteria.
作者
南玲
王豪
刘丁
NAN Ling;WANG Hao;LIU Ding(Daping Hospital, the Infection Control Division of Field Surgery Institute, the Third Affiliated Hospital of Army Medical University, Chongqing, 400042, Chin)
出处
《临床急诊杂志》
CAS
2018年第4期225-229,共5页
Journal of Clinical Emergency
关键词
新生儿重症监护病房
呼吸机相关肺炎
病原菌
耐药性
neonatal intensive care unit lventilator associated pneumonia
pathogen
drug resistance
