新生儿呼吸机相关性肺炎病原菌分布及其耐药性分析

目的了解新生儿重症监护室(NICU)患者呼吸机相关性肺炎(VAP)的病原菌特点及其耐药性,探讨其相应的防治措施,为针对VAP患者的抗菌药物治疗提供依据。方法选择蚌埠医学院第一附属医院2015年1月至2017年1月NICU中使用呼吸机机械通气的57例患儿为研究对象,采用回顾性分析方法统计确诊为VAP的患儿的临床资料、病原菌构成,并对病原菌耐药情况进行分析。结果共检出44株病原菌,革兰阴性菌所占比例为100.00%,未检出革兰阳性菌。检出率前3位的致病菌依次为鲍曼不动杆菌(36.36%,16/44),铜绿假单胞菌(25.00%,11/44),肺炎克雷伯杆菌(20.45%,9/44)。药敏试验结果显示,病原菌对氨苄西林/舒巴坦、头孢他啶、头孢唑啉等均耐药,且对亚胺培南、头孢曲松的药物敏感性明显下降。出生体重、1min Apgar评分、插管次数、住院时间、机械通气时间、胎龄、母亲年龄、原发疾病为新生儿VAP发生的独立危险因素。结论新生儿VAP致病菌以革兰阴性菌为主,且耐药率较高。新生儿VAP的发生与出生体重、胎龄、机械通气时间、插管次数等因素有关。

Distribution and drug resistance of pathogens causing ventilator-associated pneumonia in newborns

Abstract: Objective To learn the distribution and drug resistance of pathogens causing ventilator associated pneumonia (VAP) in neonatal intensive care unit (NICU), explore the corresponding prevention measures, and provide a basis for treatment of VAP with antimicrobial drugs. Methods 57 newborns who used breathing machine for mechanical ventilation in the NICU of our hospital from Jan. 2015 to Jan. 2017 were included. The clinical data of patients, pathogen distribution and drug resistance were retrospectively analysed. Results A total of 44 strains of pathogenic bacteria were isolated, all of which were Gram-negative bacteria. The top three pathogenic bacteria were Acinetobacter baumannii (36.36%, 16/44), Pseudomonas aeruginosa (25.00%, 11/44) and Klebsiella pneumoniae (20.45%, 9/44). These pathogens showed high resistance rates to Ampicillin/Sulbactam, Cefazolin and Cephalosporins. Their drug sensitivity to Imipenem and Ceftriaxone decreased obviously. Birth weight, 1 min Apgar score, times of tracheal intubation, length of hospital stay, time of mechanical ventilation, gestational age, maternal age and primary disease were the independent risk factors for neonatal VAP. Conclusion The main pathogens of neonatal VAP are Gram-negative bacteria with high drug resistance. Birth weight, 1 min Apgar score, times of tracheal intubation and time of mechanical ventilation are significantly associate with neonatal VAP.