我院早产儿感染性肺炎的病原菌分布及相关因素分析

目的探讨本地区早产儿感染性肺炎病原学及其相关影响因素．为临床经验性使用抗菌药物提供参考依据。方法回顾分析2003年1月至2007年12月期间收住新生儿科的早产儿感染性肺炎的病原菌分布、药敏结果及其影响因素。结果符合感染性肺炎的早产儿107例，社区获得性肺炎（CAP）40例，院内感染性肺炎（NAP）67例，其中51例早产儿接受呼吸机支持治疗，发生呼吸机相关肺炎35例，发生率68．6％。在送检110份咽部分泌物标本中。分离到阳性菌株86株，阳性率78．18％，其中G＋球菌占14．3％，G-杆菌占85．7％。CAP和NAP的病原菌主要均为肺炎克雷伯菌。肺炎克雷伯菌对第三代头孢菌素具有较高的耐药率，对亚胺培南全部敏感。金黄色葡萄糖球菌对万古霉素全部敏感，对青霉素全部耐药。结论本地区早产儿感染性肺炎以院内感染为主，肺炎克雷伯菌是早产儿院内及院外感染性肺炎的主要病原菌，G＋球菌对万古霉素全部敏感。对青霉素全部耐药。G-杆菌对第三代头孢菌素耐药率高。临床治疗应避免危险因素并根据病原菌及药敏结果合理使用药物。

Distribution and drug resistance of pathogenic bacteria in pneumonia of premature infants

Objective To investigate the distribution and drug resistance of pathogenic bacteria in community-acquired pneumonia （CAP） or nosocomium-acquired pneumonia （NAP） of premature infants, Methods Total 107 premature infants with infective pneumonia, including 40 cases of CAP and 67 cases of NAP were treated in our hospital from January 2003 to December 2007. The clinical data, including the distribution of pathogenic bacteria and the results of drug sensitivity tests were retrospectively reviewed. Results Among 107 premature infants, 51 cases underwent mechanical ventilation and 35 suffered from ventilator associated pneumonia with an incidence rate of 68.6%. Total 110 pharyngeal secretion specimens were collected for culture and 86 positive samples were isolated with a positive rate of 78.18%. Among these samples, Gram-positive bacteria accounted for 14.3% and Gram-negative bacteria accounted for 85.7%. Klebsiella pneumonia was the most common bacteria in both CAP and NAP cases, which was resistant to third-generation cephalosporin, but sensitive to imipenem. ALL Staphylococcus were sensitive to vancomycin but resistance to penicillin. Conclusion Klebsiella pneumonia is the most common pathogenic bacteria of CAP or NAP in premature infants, the bacterial culture and drug sensitivity tests are important for appropriate application of antibiotics.