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目的探讨大型综合医院新生儿呼吸机相关肺炎的病原菌构成及耐药情况。方法收集2012年6月—2016年6月在武汉大学人民医院接受治疗的儿童患者呼吸机相关肺炎痰液标本,接种于血琼脂平皿及巧克力平皿上并挑取可疑菌落采用BD Phoenix TM 100全自动细菌鉴定药敏系统进行检测,并采用纸片法补充部分进行药敏试验,采用Whonet 5.6软件处理数据。结果 696份痰标本阳性标本478例,分离出病原菌336株,其中革兰阴性菌233株(69.35%),以绿脓杆菌、鲍氏不动杆菌、肺炎杆菌和大肠杆菌为主;革兰阳性菌86株(25.60%),以金黄色葡萄球菌、表皮葡萄球菌、肠球菌为主;真菌17株(5.06%),以白色念珠菌为主。绿脓杆菌对环丙沙星、庆大霉素、氯霉素和四环素抗菌药物的耐药率均超过54%;鲍氏不动杆菌对哌拉西林、环丙沙星、左氧氟沙星抗生素的耐药率均超过91%;肺炎杆菌和大肠杆菌都对氨苄西林抗生素的耐药率最高为93.9%和93.5%,且超广谱β-内酰胺酶(ESBLs)检出率分别为36.4%和19.4%,差异无统计学意义(χ~2=2.29,P>0.05)。金黄色葡萄球菌、表皮葡萄球菌、肠球菌均对青霉素的耐药率最高分别为90.0%、100.0%、100.0%。革兰阳性球菌未检出万古霉素和利奈唑胺耐药;金黄色葡萄球菌和表皮葡萄球菌的苯唑西林的耐药率相比,差异有统计学意义(χ~2=11.42,P<0.05)。结论革兰阴性杆菌是导致儿童患者呼吸机相关肺炎最主要的病原菌,对常用抗菌药物的耐药情况复杂多样,严格消毒机械通气设备,加强其病原菌的耐药性监测,合理使用抗菌药物,对指导临床合理用药具有重要意义。
Objective To investigate the pathogenic bacteria composition and drug resistance of neonatal ventilator-associated pneumonia in large general hospitals. Methods The sputum samples of ventilator-associated pneumonia from children patients treated at Wuhan University People’s Hospital from June 2012 to June 2016 were collected, inoculated on blood agar plates and chocolate plates and suspicious colonies were picked up using BD Phoenix TM 100 automatic Bacterial identification drug susceptibility testing system, and the use of paper supplements for drug susceptibility testing, using Whonet 5.6 software processing data. Results A total of 478 specimens were positive in sputum from 476 sputum samples. 336 pathogens were isolated, of which 233 were gram-negative bacteria (69.35%), mainly Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli. Gram- Strain 86 (25.60%), Staphylococcus aureus, Staphylococcus epidermidis, enterococci; fungi 17 strains (5.06%), mainly Candida albicans. Pseudomonas aeruginosa resistance to ciprofloxacin, gentamicin, chloramphenicol and tetracycline antibiotics were more than 54%; Acinetobacter baumannii piperacillin, ciprofloxacin, levofloxacin antibiotic resistance The rates of resistance to ampicillin were both 93.9% and 93.5%, and the detection rates of extended-spectrum β-lactamases (ESBLs) were 36.4% and 19.4% respectively , The difference was not statistically significant (χ ~ 2 = 2.29, P> 0.05). Staphylococcus aureus, Staphylococcus epidermidis, enterococci were the highest rates of resistance to penicillin were 90.0%, 100.0%, 100.0%. Gram-positive cocci did not detect vancomycin and linezolid resistance; Staphylococcus aureus and Staphylococcus epidermidis oxacillin resistance rates compared to the difference was statistically significant (χ ~ 2 = 11.42, P < 0.05). Conclusions Gram-negative bacilli are the most important pathogenic bacteria causing respiratory-related pneumonia in children. The resistance to commonly used antibiotics is complex and diverse. The mechanical ventilation equipment is strictly disinfected, and the drug resistance of the pathogen is monitored. The antibacterial agents Guiding the rational use of clinical medicine is of great significance.