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目的研究新生儿重症监护病房(NICU)医院获得性肺炎(HAP)临床和微生物学特点,为医院感染病例及时监测、早期诊断和治疗提供依据。方法 2008年1月-2009年12月NICU监测并确诊医院获得性肺炎68例,分析研究临床及病原菌特点。结果 68例患儿中,男性比例稍高,占54.41%,低出生体重早产儿占82.44%;患儿临床症状和体征不典型,X线表现肺部纹理增多或增强的阳性率为79.41%,右肺斑片影、双肺斑片影、左肺斑片影阳性率分别为36.76%、33.82%、10.29%;68例HAP患儿的痰培养中检出病原菌37株,均为革兰阴性杆菌,最有效的抗菌药物是亚胺培南和美罗培南,其次为加酶抑制剂的复合制剂。结论 NICU医院获得性肺炎的临床症状和体征常不典型,使其早期诊断有一定的困难;采用X线影像检查协助诊断非常必要;亚胺培南、美罗培南和加酶抑制剂的复合制剂可以作为经验治疗用药。
Objective To study the clinical and microbiological characteristics of nosocomial pneumonia (HAP) in neonatal intensive care unit (NICU) and provide the basis for timely monitoring, early diagnosis and treatment of nosocomial infections. Methods From January 2008 to December 2009, NICU monitored and confirmed 68 cases of hospital-acquired pneumonia and analyzed the clinical and pathogenic characteristics. Results 68 cases of children, a slightly higher proportion of men, accounting for 54.41%, low birth weight premature children accounted for 82.44%; children with clinical symptoms and signs of atypical X-ray showed increased or enhanced lung texture positive rate was 79.41% The positive rates of right lung patch, double patch patch and left patch patch were 36.76%, 33.82% and 10.29% respectively. Thirty-seven pathogenic bacteria were detected in sputum of 68 HAP children, all of which were Gram-negative Bacilli, the most effective antimicrobial agents were imipenem and meropenem, followed by a combination of enzyme inhibitors. Conclusion NICU hospital-acquired pneumonia clinical symptoms and signs are often not typical, making it difficult to make early diagnosis; the use of X-ray imaging to assist in the diagnosis is necessary; imipenem, Meropenem and enzyme inhibitors combined preparations can As an empirical treatment medication.