机械通气新生儿下呼吸道感染病原菌分析

目的 分析新生儿重症监护病房机械通气新生儿下呼吸道感染病原菌分布及耐药性特点.方法 对机械通气超过48 h的107例新生儿下呼吸道分泌物做病原菌培养及药物敏感试验.结果 机械通气新生儿下呼吸道病原菌检出率为76.6%(82/107),其中革兰阳性菌占13.4%(11/82),革兰阴性菌占81.7%(67/82),真菌占4.9%(4/82);肺炎克雷白菌是最常见的革兰阴性菌,占59.7%(40/67),其中82.5%(33/40)的肺炎克雷白菌为产超广谱β内酰胺酶的菌株,对头孢菌素普遍耐药,对添加β内酰胺酶抑制剂的抗生素敏感性较高,对亚胺培南、环丙沙星、阿米卡星敏感性高.结论 机械通气新生儿下呼吸道感染病原菌主要是革兰阴性菌,且多为耐药性条件致病菌,以产超广谱β内酰胺酶的菌株肺炎克雷白菌为主.

An analysis of bacterial pathogens in low respiratory tract infection in neonate with mechanical ventilation

Objective To investigate the characteristics of low respiratory Watt pathogenic bacteria and their antimicrobial resistance in neonate with mechanical ventilation in intensive care unit.Methods An retrospective clinical data of analysis of low respiratory tract secretion culture and drug-sensitivity test was done to 107 newborns with mechanical ventilation ＞48 hours.Results The incidence rate of low respiratory tract infection in neonates with mechanical ventilation was 76.6%(82/107).The rate of Gram-positive bacteria was 13.4%(11/82),that of Gram-negative bacteria was 81.7%(67/82)and that of the fungi was 4.9%(4/82).The most common Gram-negative bacteria was Klebsiella pneumonia which was 59.7%(40/ 67)and with 82.5 % being ESBLs-producing strains(33/40).The resistance of ESBLs-producing Klebsiella pneumonia was higher to cephalosporins and the resistance to antibiotics supplemented with β-lactamaseinhibitors were significantly lower,but sensitive to tienam,ciprofloxacin and amikacin.Conclusion The main pathogens of low respiratory tract infection are Gram-negative bacteria and drug-resistant opportunistic bacteria in neonate with mechanical ventilation.ESBLs-producing Klebsiella pneumonia is the major pathogen.