674例新生儿败血症病原学及耐药性分析

目的:了解新生儿败血症病原学特点和致病菌耐药酶的产生与抗生素应用的相关性,为临床及时明确病原、正确选用抗生素提供依据。方法:对12年间新生儿科5 350例发热新生儿患儿无菌采集血液进行细菌培养,同时进行药敏分析和耐药酶检测,并了解采集标本前抗生素的应用情况。结果:5 350份血液标本中检出需氧菌674株,阳性率12.6%,其中革兰阴性杆菌155株,占23.0%,革兰阳性球菌504株,占74.8%。排在前八位的菌种是表皮葡萄球菌、溶血葡萄球菌、嗜麦芽假单胞菌、人葡萄球菌、肺炎克雷伯菌、大肠埃希菌、不动杆菌、粪肠球菌。革兰阳性球菌对青霉素,哌拉西林,苯唑西林耐药性高,对万古霉素100%敏感;革兰阴性杆菌对氨苄西林、哌拉西林,头孢呋辛耐药性高,对亚胺培南、头孢三代较敏感;感染产耐药酶菌患儿在检测前使用抗生素比率高于感染但未产耐药酶菌的患儿比率(X2=6.55,P<0.05),尤其第三代头孢菌素的应用,差异更显著(X2=12.17,P<0.005)。结论:新生儿败血症病原菌以表皮葡萄球菌和非发酵菌为主,但溶血葡萄球菌有上升趋势。加强各类标本的细菌学检测,预防败血症,减少耐药菌株的产生。

Analysis of Pathogens and Drug Resistance in 674 Cases of Neonatal Sepsis

Objective:To investigate pathogenic characteristics in neonatal sepsis and the production of bacterial resistant enzymes and its relevance to antibiotics application so as to provide evidence for early and clear diagnosis of clinical pathogens and rational use of antibiotics.Methods: The blood of the 5 350 fever cases at the Neonatology Ward over the past 12 years was collected for bacterial culture,susceptibility analysis and detection of drug resistant enzymes were carried out,and antibiotics application prior to the sample collection was also reviewed.Results: Out of the 5 350 blood samples,674 stains were detected(a positive rate of 12.6 %),Gram-negative bacilli(155 strains) accounting for 23.0 % and Gram-positive cocci(504 strains) accounting for 74.8 %.Staphylococcus epidermidis,Staphylococcus haemolyticus,Aeromonas malt aeruginosa,Staphylococcus,Klebsiella pneumoniae,Escherichia coli,Acinetobacter and Enterococcus faecalis were the eight most common pathogens.Gram-positive cocci demonstrated a strong resistance to penicillin,piperacillin and oxacillin and was 100 % sensitive to vancomycin;resistance of Gram-negative bacilli to ampicillin,piperacillin and cefuroxime was high and their susceptibility to imipenem and third-generation cephalosporins was evident.Compared with the infected neonates who were without bacteria-induced resistant enzymes,those with such enzymes showed a higher rate of antibiotics application before the detection(X2=6.55,P<0.05),and the difference was more significant with the application of third-generation cephalosporins(X2=12.17,P<0.005).Conclusion: Staphylococcus epidermidis and non-fermentative bacteria are main pathogens in neonatal sepsis and there is an upward trend with Staphylococcus haemolyticus.Bacterial detection of various specimens shall be strengthened to prevent sepsis and reduce the emergence of resistant strains.