早产儿呼吸机相关性肺炎病原菌分析

目的:调查早产儿呼吸机相关性肺炎病原菌的分布及耐药特点,指导临床合理用药。方法:分析2007年3月~2008年3月发生呼吸机相关性肺炎的64例早产儿的病原菌谱及耐药性。结果:64例呼吸机相关性肺炎患儿中28例分泌物培养阳性,阳性率43.75%,培养出病原菌32种。其中G-杆菌阳性24例(占75.00%),G+球菌阳性7例(占21.88%),合并真菌感染(假丝酵母菌)1例。G-杆菌中ESBLs分离率29.9%,葡萄球菌中BLs分离率66.67%;G-杆菌中ESBLs阳性者仅对美洛培南及阿米卡星高度敏感,葡萄球菌BLs阳性者仅对万古霉素敏感。结论:早产儿呼吸机相关性肺炎病原菌以G-杆菌为主,G+球菌次之,同时合并真菌的感染,致病菌耐药率高,临床医师应根据病原菌以及药敏试验合理选择抗菌药物。

Analysis on pathogens of ventilator-associated pneumonia in premature infants

To investigate the distribution of pathogens of ventilator-associated pneumonia (VAP) in premature in-fants and characteristics of antimierobial resistance, direct rational administration of drug in clinic. Methods: Bacterial Spectrum and drug resistance of 64 premature infants with VAP were analyzed from March 2007 to March 2008. Results: The positive rate of secretion from 64 premature infants was 43.75% (28/64), 32 bacteria strains were isolated, the percentages of gram-negative bacilli and gram-positive cocci were 75.00% (24/32) and 21.88% (7/32), and mycotic infection was found in one case. The isolated rate of ESBLs in gram-neg-ative bacilli was 29. 9%, and the isolated rate of BLs in staphylococci was 66. 67% ; gram-negative bacilli with positive ESBLs were sensi-tive to meropenem and amikacin; staphylococci with positive BLs were sensitive to vancomyein. Conclusion: Gram-negative bacilli are the main pathogens of VAP in premature infants, the secondary is gram-positive cocci, drug resistance is high, clinicians should choose antimi-crobial agents according to pathogen and antimicrobial susceptibility test result.