新生儿重症监护病房呼吸机相关肺炎病原学分析

目的调查我院新生儿重症监护病房(NICU)呼吸机相关肺炎(Ventilator Associated Pneumonia,VAP)病原菌的分布及耐药特点,指导临床合理用药.方法分析我院NICU病房2003年10月～2005年10月发生VAP患者的临床特征、病原菌谱及耐药性.结果45例VAP患者共检出58株病原菌,革兰阴性(G-)杆菌占70.69%,革兰阳性(G )球菌占12.07%,真菌占17.24%,G-杆菌以铜绿假单胞菌(20.69%)为多,G 球菌主要为金黄色葡萄球菌(5.17%),真菌主要为白色念珠菌(10.34%).G-杆菌对阿米卡星、泰能较敏感;革兰阳性(G )球菌对万古霉素均敏感.结论NICU病房VAP病原菌以G-杆菌为主,耐药率高,真菌感染居第二位,临床医师应根据病原菌以及药敏试验合理选择抗菌药物.

Pathogenic analysis of Ventilator Associated Pneumonia in NICU

Objective To investigate the distribution of bacteria causing ventilator associated pneumonia(VAP) and characteristics of antimicrobial resistance in NICU, and to provide guidance for the rational antimicrobial use in clinic. Methods Clinical characteristics, bacteria causing VAP and antimicrobial resistance during OCtober 2003-October 2005 were analyzed. Results Among 58 strains isolated from 45 cases with VAP, the percentage of gram-negative bacilli, gram-positive cocci and fungi was 70.69%, 12.07% and 17.24%, respectively. Pseudomonas aeruginosa was the major isolated bacteria among gram-negative strains(20.69%), staphylococcus aureus was the most common isolated bacteria among gram-positive strain(5.17%), and Blastomyces albicans was the most common isolated bacteria among fungi (10.34%). Gram-negative bacteria were sensitive to Amikacin and Imipenem/Cilastatin. The sensitive rates of gram-positive cocci strains to Vancomycin were all 100%. Conclusions Gram-negative bacteria are the main pathogens causing VAP in patients in NICU, and bacteria strains have high antimicrobial resistance, fungi was the second place, clinicians should choose antimicrobial agents according to pathogen and antimicrobial susceptibility test result.