Analysis of drug resistance and distribution of pathogenic bacteria of ventilator-associated pneumonia in neonatal intensive care unit
-
摘要: 目的: 了解新生儿重症监护病房 (NICU) 呼吸机相关肺炎 (VAP) 病原菌分布及其耐药性发展趋势, 为临床抗菌药物合理使用提供参考依据。方法: 通过前瞻性目标监测, 对2015-01-2017-12期间入住NICU实施机械通气治疗的患儿发生VAP病原菌进行监测和药敏试验结果分析。结果: 纳入监测的884例患儿中, 发生VAP116例, 发生率为13.12%;共分离病原菌120株, 其中革兰阴性杆菌106株 (88.33%), 革兰阳性球菌8株 (6.67%), 真菌6株 (5.00%);检出致病菌居前3位分别为鲍曼不动杆菌 (49.17%)、肺炎克雷伯菌 (22.50%) 和铜绿假单胞菌 (8.33%)。鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌对亚胺培南和美洛培南的耐药率分别是96.61%、18.52%和40.00%;凝固酶阴性葡萄球菌均为甲氧西林耐药株。结论: 建立多重耐药预警监测机制, 及时掌握NICU呼吸机相关肺炎病原菌的临床分布及耐药特点, 合理使用抗菌药物, 减少耐药菌的产生。Abstract: Objective: To understand the distribution of pathogenic bacteria and the development trend of drug resistance in neonatal intensive care unit (NICU) ventilator associated pneumonia (VAP), providing a reference for the rational use of antibacterial drugs.Method: Through prospective target monitoring, the results of monitoring and drug sensitivity test were analyzed for the patients who were admitted to NICU from January 2015 to December 2017 for the implementation of mechanical ventilation treatment.Result: Among 884 cases of monitoring newborn, 116 had VAP, with the morbidity rate 13.12%;A total of 120 strains of pathogens were isolated, gram-negative bacteria for 88.33% (106/120), gram-positive bacteria 6.67% (8/120), and fungi 5.00% (6/120).The top three pathogens were Acinetobacterbaumannii (49.17%)、klebsiellapneumoniae (22.50%) and Pseudomonas aeruginosa (8.33%).Antimicrobial resistance rates of Acinetobacterbaumannii、klebsiellapneumoniae and Pseudomonas aeruginosa to imipenem and meropenem were 96.61%、18.52% and 40.00% respectively;coagulase negative staphylococcus are all methicillin-resistant.Conclusion: Establishment of multi-drug resistance warning monitoring mechanism, it is necessary to understand the distribution and antobiotic resistance of the Ventilator Associated Pneumonia in NICU for better control and prevention of such infections, which promotes rational use of antimicrobial agents, reduces the production of resistant bacteria.
-
-
[1] 赵季欣, 封成芳, 许全珍.NICU呼吸机相关性肺炎病原菌分布及耐药性分析[J].北方药学, 2015, 12 (4):163-164.
[2] 陈彦香, 陈少峰, 吴瑛, 等.2007-2010年NICU中细菌分布及耐药变迁的分析[J].中国抗生素杂志, 2013, 38 (3):227-238.
[3] Kollef M H, Afessa B, Anzueto A, et al.Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia:the NASCENT randomized trial[J].JAMA, 2008, 300:805-813.
[4] Geffers C, Baerwolff S, Schwab F, et al.Incidence of healthcare associated infections in high-risk neonates:results from the German surveillance system for verylow-birthweight infats[J].J Hosp Infect, 2008, 68:2014-224.
[5] Foglia E, Meier M D, Elward A.Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients[J].Clin Mircobiol Rev, 2007, 20:409-425.
[6] 景建军, 何光辉, 李晓峰.监护室使用呼吸机发生相关性肺炎的危险因素分析[J].临床急诊杂志, 2017, 18 (11):838-841.
[7] 张燕, 朱保锋, 陈建荣.卒中相关性肺炎相关危险因素的研究[J].临床急诊杂志, 2015, 16 (11):825-828.
[8] 吕华, 吴秀英, 王燕儿.NICU呼吸机相关性肺炎的病原学分析[J].中华医院感染学杂志, 2012, 22 (1):182-184.
[9] 随素敏, 云磊, 魏广友, 等.NICU新生儿呼吸机相关性肺炎病原菌分布与耐药性分析[J].中华医院感染学杂志, 2016, 26 (5):1138-1140.
[10] Tekin R, Dal T, Pirinccioglu H, et al.A 4-year surveillance of device-associated nosocomial infections in a neonatal intensive care unit[J].Pediatr Neonatol, 2013, 54, 303-308.
[11] 王丹, 许颖.鲍曼不动杆菌的分布特征及耐药性分析[J].国际检验医学杂志, 2013, 34 (3):361-363.
[12] 胡付品, 郭燕, 朱德妹, 等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志, 2017, 17 (5):481-491.
[13] 孙珊, 张莉萍.鲍曼不动杆菌临床菌株生物膜形成能力的研究[J].中国微生态学杂志, 2011, 23 (12):1107-1109.
[14] 吕春兰, 杭国琴, 许云, 等.重症监护病房导管相关血流感染的病原菌分布与耐药分析[J].中国感染与化疗杂志, 2015, 15 (60):564-568.
[15] 孟玲宁, 刘锦燕, 李文静, 等.白念珠菌与生物膜相关的耐药机制[J].中国真菌学杂志, 2017, 12 (2):124-127.
-
计量
- 文章访问数: 208
- PDF下载数: 829
- 施引文献: 0
下载: