非支气管镜支气管肺泡灌洗法对新生儿呼吸机相关性肺炎病原菌的检测

目的：探讨新生儿呼吸机相关性肺炎(VAP)的主要病原菌，寻求防治措施。方法：应用非支气管镜支气管肺泡灌洗法对56例呼吸机相关性肺炎患儿进行灌洗液培养，同时作药物敏感实验。结果：分离出病原菌61株，其中G^ 球菌34株(55．73％)，主要为血浆凝固酶阴性葡萄球菌、表皮葡萄球菌、变异链球菌。G^-杆菌25株(40．98％)，依次为肺炎克雷伯杆菌、铜绿假单胞菌、阴沟杆菌、大肠埃希氏菌、不动杆菌、产气肠杆菌。白色念珠菌2株(3．28％)。致病菌耐药率高，对泰能、万古霉素、环丙沙星较为敏感。结论：非支气管镜支气管肺泡灌洗法对新生儿呼吸机相关性肺炎病原菌检测安全可靠、灵敏度高、特异性强。VAP的病原以G^ 球菌为主，应根据致病菌的药敏合理选用抗生素。

Nonbrochoscopic Bronchoalveolar Lavage to Detect the Characteristics of Pathogenic Bacteria in Newborns with Ventilator-associated Pneumonia

Objective:To study the characteristics of pathogenic bacteria in bronchoalveolar in newborns with ventilator-associated pneumonia (VAP) in order to establish more effective treatment and prophylaxis regiments. Methods: Lavage lotion were collected using the method of nonbrochoscopic bronchoalveolar lavage (NBBAL) for bacteria culture and drug -sensitivity testing in 56 newborn with VAP. Result :There were 61 bacterial strains cultured from 56 patients. 34(55. 73%)cultures yielded Gram-positive cocci, including 23 Coagulase-negative Staphlococci, 6 Epidermis staphylo-coccus, 5 Variation streptococcus. There were 25 (40. 98%) Gram-negtive bacteria, of which 10 Klebsiella pneumoni-ae, 8 Pseudomonas aeruginosa, 3 Enterobacter cloacae, 2 Escherichia coli, 1 Acinetobacter baurnanii, 1 Enterobacter aerogenes. Two cultures were Candida albicans(3. 28%). They were highly tolerant to antibiotics, but sensitive to tien-am. vancomycin and ciprofloxacin. Conclusion: The method of nonbrochoscopic bronchoalveolar lavage was safe, reliable , sensitive and specific. Gram-positive cocci account ed for the majority of pathogens in newborn with VAP. Antibiotics should be appropriately used according to drug-sensitivity testing.