NICU新生儿呼吸机相关性肺炎病原菌分布及耐药性分析

目的:呼吸机相关性肺炎(VAP)发病率逐年增高,致残率、致死率也呈上升趋势.分析NICU中新生儿(VAP)的病原菌分布以及耐药性,为抗生素治疗VAP的提供科学依据。方法:回顾分析2001年1月至2007年1月重庆医科大学儿童医院新生儿科89例新生儿VAP患儿临床资料、痰培养及药敏结果。结果:89例VAP患者共分离病原菌155株,革兰阴性杆菌占80%,革兰阳性菌占12.3%,真菌占7.7%。病原菌以肺炎克雷伯杆菌(27.1%),鲍曼不动杆菌0、铜绿假单胞菌和大肠埃希菌为主要致病菌。分离的细菌除对泰能较敏感外,对其他抗生素均有不同程度耐药。结论:VAP的病原菌构成以革兰阴性杆菌为主且呈现出多重耐药现象,适当的最初经验性抗菌治疗应遵依据于本地区最新的病原学和耐药性的监测结果。

Analyze of the Pathogens and drug Resistance in Newborns with Ventilator-associated Pneumonia in NICU

Objective The morbidity and mortality of ventilatorassociated pneumonia(VAP)has been increased in the decade of years.The order of this study is to analyze the pathogens and drug resistance in newborns with ventilator- associated pneumonia in NICU to determine the corresponding clinical treatment strategies.Methods The clinical records and results of sputum cultivation and bacterial susceptibility of 89 cases with YAP were retrospectively analyzed,which were admitted to the Neonatal Intensive Care Unit in the Children's Hospital affiliated to Chongqing Medical University from January 2001 to January 2007.Results One hundred and fifty five strains were isolated from specimens with Gram negative bacilli(80%),Gram positive cocci(12.3%)and fungus(7.7%).The most common isolated bacteria of the pathogen spectrum in YAP were Klebsiella pneumoniae(27.1%),Acinetobacter baumannii(18.7%),Pseudomonas aeruginosa(11%)and Escherichia coli(8.4%).All the isolated strains showed resistance to all the agents tested in different levels Except ipenem. Conclusions The major pathogens in VAP are often multiple drug-resistantive Gram negative bacilli.It is suggested that the initial empiric antimicrobial therapy should base on the the surveillance of etiology and resistance.