新生儿社区和院内获得性肺炎的病原学特点及药敏分析

发布时间：2018-04-25 06:22

本文选题：社区获得性肺炎 + 院内获得性肺炎　；参考：《临床儿科杂志》2016年07期

【摘要】：目的探讨新生儿社区获得性肺炎(CAP)和院内获得性肺炎(HAP)的病原分布和药敏情况。方法回顾性分析2010年1月—2014年12月因新生儿肺炎住院且痰培养阳性新生儿的临床资料。结果在3 564例CAP新生儿中共检出病原微生物4 383株,其中细菌3 584株、病毒771、真菌7株及非典型病原体21株。细菌以革兰阴性菌为主,3 045株(85.0%),细菌中排名前三的为肺炎克雷伯菌、大肠埃希菌及金黄色葡萄球菌;病毒以呼吸道合胞病毒为主,693株(89.9%)。在344例HAP新生儿中共检出病原微生物424株,其中细菌402株,真菌17株,呼吸道合胞病毒5株。细菌均为革兰阴性菌,未发现革兰阳性菌,排名前三的为肺炎克雷伯菌、大肠埃希菌及鲍曼不动杆菌。CAP与HAP新生儿中革兰阴性菌产ESBLs菌分别为26.9%、46.8%,差异有统计学意义(P?0.05)。CAP、HAP的肺炎克雷伯菌和大肠埃希菌均对阿米卡星、碳青霉烯类高度敏感。HAP的肺炎克雷伯菌对常用抗菌药物(除阿米卡星、喹诺酮类外)的敏感性普遍低于CAP,差异有统计学意义(P?0.05);HAP的大肠埃希菌对常用抗菌药物(除阿米卡星、喹诺酮类及碳青霉烯类外)的敏感性普遍低于CAP,差异有统计学意义(P?0.05)。此外,还发现耐碳青霉烯类的肠杆菌。结论新生儿肺炎病原菌以革兰阴性菌为主,其中CAP以肺炎克雷伯菌、大肠埃希菌及金黄色葡萄球菌为主,HAP以肺炎克雷伯菌、大肠埃希菌及鲍曼不动杆菌为主。HAP致病菌的产酶率和耐药性均普遍高于CAP,且有多重耐药趋势。
[Abstract]:Objective to investigate the pathogenic distribution and drug sensitivity of neonatal community acquired pneumonia (CAP) and nosocomial pneumonia (HAP). Methods the clinical data of neonates with sputum culture positive from January 2010 to December 2014 were analyzed retrospectively. Results A total of 4 383 strains of pathogenic microorganisms were detected in 3 564 neonates with CAP, including 3 584 strains of bacteria, 77 1 strains of virus, 7 strains of fungi and 21 strains of atypical pathogens. The main bacteria were Gram-negative bacilli (3 045), Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus, and respiratory syncytial virus (RSV) were 693 strains (89. 9%), among which the top three were Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus. A total of 424 strains of pathogenic microorganisms were detected in 344 neonates with HAP, including 402 strains of bacteria, 17 strains of fungi and 5 strains of respiratory syncytial virus. The bacteria were all gram-negative bacteria, no Gram-positive bacteria were found, and the top three were Klebsiella pneumoniae. Escherichia coli, Acinetobacter baumannii. CAP and Gram-negative bacilli of HAP were 26.9% and 46.8%, respectively. The difference was statistically significant between Klebsiella pneumoniae and Escherichia coli. The susceptibility of Klebsiella pneumoniae, which is highly sensitive to carbapenes, to common antimicrobial agents (except amikacin and quinolones) is generally lower than that of CAP.The difference is statistically significant between Escherichia coli and common antimicrobial agents (except amikacin). The sensitivity of quinolones and carbapenes was generally lower than that of CAP.The difference was statistically significant. In addition, it was also found that carbapenem resistant Enterobacter spp. Conclusion Gram-negative bacteria are the main pathogens of neonatal pneumonia, and Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus are the main pathogens of CAP. The enzyme production rate and drug resistance of Escherichia coli and Acinetobacter baumannii were higher than those of CAP, and there was a trend of multidrug resistance in Escherichia coli and Acinetobacter baumannii.
【作者单位】：重庆医科大学附属儿童医院新生儿诊治中心儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室儿童发育重大疾病国家国际科技合作基地;
【分类号】：R446.5;R722.135

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