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目的通过对新生儿感染性肺炎细菌学分析,探讨社区获得性肺炎和医院感染性肺炎细菌学特点,更好地指导临床应用抗生素。方法根据肺炎获得的地点分为社区获得性肺炎(CAP)和医院感染性肺炎(HAP)。CAP于入院24 h取痰。HAP于胸部X线片证实后取痰。应用法国梅里埃公司VTTEK细菌鉴定仪鉴定菌种,药敏采用KB纸片扩散法。结果肺炎克雷伯菌是本研究中CAP组和HAP组共同的主要致病菌。大肠埃希菌为CAP组中第2位,鲍氏不动杆菌为HAP组致病第2位。药敏试验分析,肺炎克雷伯菌和鲍氏不动杆菌对较常用的青霉素类和头孢类耐药率高。肺炎克雷伯菌和大肠埃希菌对亚胺培南均敏感,4例鲍氏不动杆菌对亚胺培南不敏感。CAP组和HAP组中革兰氏阴性杆菌产ESBLs分别为18.2%和42.9%,可能与患儿在住院期间使用三代头孢菌素有关。结论新生儿CAP致病菌有明显地区差异,应根据各地检测结果指导临床使用抗生素。
Objective To explore the bacteriological characteristics of community-acquired pneumonia and nosocomial pneumonia by bacteriological analysis of neonatal pneumonia and better guide the clinical application of antibiotics. Methods According to the location of pneumonia were divided into community-acquired pneumonia (CAP) and nosocomial pneumonia (HAP). CAP admitted to hospital 24 h sputum. HAP sputum after the chest X-ray confirmed. Application French company MEIXE VTTEK bacterial identification instrument identification, drug susceptibility KB disk diffusion method. Results Klebsiella pneumoniae was the common main pathogen of CAP and HAP in this study. Escherichia coli was the second in the CAP group and Acinetobacter baumannii was the second in the HAP group. Drug sensitivity test analysis, Klebsiella pneumoniae and Acinetobacter baumannii more commonly used penicillins and cephalosporins resistance rate. Klebsiella pneumoniae and Escherichia coli were sensitive to imipenem, and Acinetobacter baumannii was not sensitive to imipenem in 4 cases. Gram-negative bacilli produced ESBLs in CAP and HAP groups were 18.2% and 42.9%, respectively, which may be related to the third generation cephalosporins used during hospitalization. Conclusions There are obvious regional differences in neonatal CAP pathogens, antibiotics should be guided by clinical test results.