新生儿社区和院内获得性肺炎的病原学特点及药敏分析

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3564例CAP新生儿中共检出病原微生物4383株，其中细菌3584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，3045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。%Objectives To explore the pathogen characteristic and drug sensitivity of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in neonates. Methods Clinical data of hospitalized neonates with pneumonia and positive sputum culture were retrospectively analyzed from January 2010 to December 2014 . Results A total of 4383 strains of pathogenic microorganisms were detected from 3564 cases of neonatal with CAP, including 3584 strains of bacteria, 771 strains of virus, 7 strains of fungus, and 21 strains of atypical pathogen. Gram negative bacteria ( 3045 strains, 85%) were the dominant bacteria. The top three bacteria were Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Respiratory syncytial virus (693 strains, 89.9%) was the dominant virus. A total of 424 strains of pathogenic microorganisms were detected from 344 cases of neonatal with HAP, including 402 strains of bacteria, 17 strains of fungus, and 5 strains of respiratory syncytial virus. Bacteria were all gram-negative bacterium and no gram-positive bacterium was found. The top three bacteria were Klebsiella pneumonia, Escherichia coli, and Acinetobacter baumannii. The positive rates of ESBLs in Gram-negative bacteria were 26 . 9%in neonates with CAP and 46 . 8%in neonates with HAP respectively, and the difference was statistically signiifcant (P< 0 . 05 ). Klebsiella pneumoniae and Escherichia coli in both CAP and HAP were highly sensitive to amikacin and carbopenems. The sensitivity of Klebsiella pneumoniae to common used antibacterial agents (except for amikacin and quinolones) in HAP was generally lower than CAP (P< 0 . 05 ). The sensitivity of Escherichia coli to common used antibacterial agents (except for amikacin, quinolones and carbapenems) in HAP was generally lower than CAP (P< 0.05). Moreover, carbapenem-resistant Enterobacteriaceae was found. Conclusions Gram-negative bacterium is the dominant pathogen in neonatal pneumonia. Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus are dominant pathogens in CAP. Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii are dominant pathogens in HAP. The enzyme-producing rate and drug resistance rate of pathogenic bacterium in HAP are generally higher than those in CAP, and there is a tendency of becoming multi-drug resistance.