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目的了解本地区2003～2006年新生儿呼吸机相关性肺炎的主要病原菌及耐药的现状,指导临床合理使用抗菌素。方法对我中心NICU2003年1月～2006年9月确诊的呼吸机相关肺炎做气管分泌物细菌培养及药物敏感实验。结果276例中188例痰液细菌培养阳性,检出率68%。机械通气≥2～5天,检出率53%,机械通气﹥5天,检出率82%。病原菌以肺炎克雷伯菌、大肠埃希氏菌、弗劳地拘橼酸杆菌、铜绿假单胞菌、血浆凝固酶阴性葡萄球菌为主要病原菌。肠杆菌对哌拉西林、氨苄西林、头孢唑啉、头孢呋辛、头孢哌酮、头孢吡肟的耐药率较高。对头孢曲松、头孢噻肟、头孢他啶、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南较敏感。血浆凝固酶阴性葡萄球菌对红霉素、阿齐霉素耐药率较高。对头孢唑啉、头孢曲松、头孢噻肟、万古霉素等敏感。铜绿假单胞菌对多种抗菌素均耐药。结论肺炎克雷伯菌、大肠埃希氏菌、弗劳地拘橼酸杆菌、铜绿假单胞菌、血浆凝固酶阴性葡萄球菌为主要病原菌,头孢曲松、头孢噻肟、头孢他啶、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南可做为呼吸机相关肺炎经验用药,以后再根据分泌物细菌培养及药物敏结果调整。机械通气﹥5天,呼吸机相关肺炎发生率高,根据病情应尽早停用呼吸机。
Objective To understand the main pathogens and drug resistance of neonatal ventilator-associated pneumonia in the region from 2003 to 2006, and to guide the rational use of antibiotics in clinic. Methods Bacterial culture and drug susceptibility testing of tracheal secretions from ventilator-associated pneumonia confirmed by NICU from January 2003 to September 2006 in our center were performed. Results A total of 188 sputum samples from 276 patients were positive for bacterial culture, with a detection rate of 68%. Mechanical ventilation ≥ 2 ~ 5 days, the detection rate of 53%, mechanical ventilation> 5 days, the detection rate of 82%. Pathogenic bacteria Klebsiella pneumoniae, Escherichia coli, Floridium citrinopilella, Pseudomonas aeruginosa, coagulase-negative Staphylococcus aureus as the main pathogen. Enterobacter piperacillin, ampicillin, cefazolin, cefuroxime, cefoperazone, cefepime resistance rate is higher. Of ceftriaxone, cefotaxime, ceftazidime, piperacillin / tazobactam, cefoperazone / sulbactam, imipenem more sensitive. Plasma coagulase-negative Staphylococcus aureus, erythromycin, azithromycin higher rate of resistance. Of cefazolin, ceftriaxone, cefotaxime, vancomycin and other sensitive. Pseudomonas aeruginosa is resistant to many antibiotics. Conclusions Klebsiella pneumoniae, Escherichia coli, Floricobacter freundii, Pseudomonas aeruginosa, coagulase-negative staphylococcus are the main pathogens, ceftriaxone, cefotaxime, ceftazidime, piperacillin / Tazobactam, cefoperazone / sulbactam, imipenem can be used as a ventilator-associated pneumonia empirical medication, and then adjusted according to secretions of bacterial culture and drug susceptibility results. Mechanical ventilation> 5 days, high incidence of ventilator-associated pneumonia, ventilator should be deactivated as soon as possible based on the condition.