新生儿重症监护室嗜麦芽窄食单胞菌肺部感染的临床特点和耐药性分析

发布时间：2018-04-28 14:05

本文选题：肺部感染 + 嗜麦芽窄食单胞菌　；参考：《广东医学》2017年17期

【摘要】：目的探讨新生儿重症监护室(NICU)嗜麦芽窄食单胞菌(SMA)肺部感染的特点及耐药性,为临床预防、感染控制和合理使用抗菌药物提供依据。方法对28例院内肺部感染SMA的临床资料进行回顾性分析。结果发生感染的高危因素包括早产、低出生体重、侵入性操作,碳青霉烯等广谱抗生素的长时间使用及胃肠外营养。在病情好转后再次出现气道分泌物增多、黏稠变黄并伴有血白细胞数异常变化、C反应蛋白和(或)降钙素原增高是肺部感染SMA早期和主要的征象。在28例患儿中所分离出的32株SMA,对美洛培南、亚胺培南、氨曲南、头孢曲松的耐药率为100%,对青霉素类,氨基糖苷类及三、四代头孢菌素的耐药率均在50%以上,但对头孢哌酮/舒巴坦、头孢西丁、复方新诺明、环丙沙星、左旋氧氟沙星的耐药率相对较低(30%);其中有19株呈多重耐药,4株对20种抗生素均耐药。结论 SMA是引起NICU院内肺部感染的重要原菌之一,合理使用抗菌药物,减少侵入性操作,缩短机械通气和住院时间,尽早拔除各种置管有利于减少感染的发生。
[Abstract]:Objective to investigate the characteristics and drug resistance of pulmonary infection of NICU in neonatal intensive care unit (NICU), and to provide evidence for clinical prevention, infection control and rational use of antimicrobial agents. Methods the clinical data of 28 patients with nosocomial pulmonary infection (SMA) were analyzed retrospectively. Results the high risk factors for infection included premature delivery, low birth weight, invasive operation, long-term use of carbapenem and other broad-spectrum antibiotics, and parenteral nutrition. The increase of airway secretion, thickening and yellowing, and abnormal white blood cell count were the early and main signs of pulmonary infection in SMA with the increase of C-reactive protein (CRP) and / or procalcitonin (procalcitonin). 32 strains of SMAs isolated from 28 children were resistant to melopenem, imipenem, aztreonam, ceftriaxone, penicillin, aminoglycoside and third and fourth generation cephalosporins. But the resistance rate of cefoperazone / sulbactam, cefoxetine, compound sulfoxacin, ciprofloxacin and levofloxacin was relatively low, and 19 of them were multidrug resistant to 20 kinds of antibiotics. Conclusion SMA is one of the most important pathogenic bacteria to cause nosocomial pulmonary infection in NICU. Rational use of antimicrobial agents, reduction of invasive operation, reduction of mechanical ventilation and hospital stay, and early extubation of various catheters are helpful to reduce the incidence of infection.
【作者单位】：广州市花都区人民医院院感科;广州市花都区人民医院新生儿科;
【分类号】：R722.13

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