摘要
目的探讨新生儿重症监护病房中行机械通气治疗的新生儿呼吸机相关性肺炎的病原菌分布、耐药性及危险因素.方法将在新生儿重症监护病房中行机械通气治疗的428例新生儿设为研究对象,统计呼吸机相关性肺炎发生率及病原菌分布,分析主要病原菌耐药性,对呼吸机相关性肺炎的危险因素进行分析.结果428例患儿中发生呼吸机相关性肺炎154例(36.0%),共检出病原菌161株,均为革兰阴性菌,检出率前3位的病原菌依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌.鲍曼不动杆菌对头孢唑林、头孢替坦、氨曲南、氨苄西林、哌拉西林、头孢呋辛钠耐药率为100%,铜绿假单胞菌对头孢曲松、头孢唑林、头孢替坦、复方新诺明耐药率为100%,肺炎克雷伯菌对头孢曲松、头孢唑林、氨苄西林耐药率为100%,对氨曲南耐药率高于90%,未发现其对左氧氟沙星、阿米卡星耐药.新生儿重症监护病房患儿出生体质量、住院时间、机械通气时间、插管次数、出生1 min后阿氏评分是影响其发生呼吸机相关性肺炎的独立危险因素(P<0.01).结论新生儿重症监护病房中呼吸机相关性肺炎发生率较高,感染的病原菌以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌等革兰阴性菌为主,且耐药性较高.临床应根据药敏试验结果,合理选择抗菌药物,同时采取综合预防措施,以降低新生儿呼吸机相关性肺炎发生率.
Objective To investigate the pathogen distribution and risk factors of neonatal ventilator asso-ciated pneumonia in neonatal intensive care unit.Methods 428 neonates who underwent mechanical venti-lation in the NICU were seen as the study objects.The incidence of VAP was statistically analyzed,and the distribution,drug resistance and VAP related risk of VAP neonatal pathogens were analyzed.Results Of the 428 neonates,154 had VAP(36.0%),and 161 pathogens were detected,all of which were Gram-negative bacteria.The top three pathogens in the detection rate were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae.The resistance rate of Acinetobacter baumanni to ce-fazolin,cefotetan,aztreonam,ampillin,piperacillin,cefuroxime sodium was 100%.The resistance rate of Pseudomonas aeruginosa to ceftriaxone,cefazolin,cefotetan,and compound trimethoprim was 100%..The resistance rate of Klebsiella pneumoniae to ceftriaxone,cefazolin and ampicillin was 100%,and the resistance rate to aztreonam was higher than 90%,no resistance to levofloxacin and amikacin was found.Birth weight,length of hospitalization,duration of m echanical ventilation,number of intubations,and Apgar score 1 min after birth in NICU patients were independent risk factors affecting ventilator associated pneumonia(P<0.01).Conclusions The incidence of ventilator-associated pneumonia in NICU is relatively high.The main pathogens of infection are Gram-negative bacteria such as Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumon-iae,and the drug resistance is high.According to the results of drug susceptibility testing,antibacterial drugs should be selected reasonably and comprehen-sive preventive measures should be taken to reduce the incidence of neonatal ventilator associated pneumo-nia.
作者
周炎娟
刘大鹏
李朝辉
范甜
曹孟晨
康文清
Zhou Yanjuan;Liu Dapeng;Li Zhaohui;Fan Tian;Cao Mengchen;Kang Wenqing(Henan Children's Hospital,Zhengzhou 450018,Henan,China)
出处
《临床心身疾病杂志》
CAS
2020年第5期114-117,121,共5页
Journal of Clinical Psychosomatic Diseases
作者简介
周炎娟。女,38岁,汉族,本科,主治医师。主要研究成果:发表专业论文多篇。研究方向:新生儿疾病诊治;通讯作者:康文清,Email:12272995@qq.com。
