新生儿败血症病原菌十年变迁及耐药性分析  

Analyzing the changes of pathogens causing neonatal septicemia and their drug resistances in last 10 years

作　　者：敖当[1] 张慧琼[1] 蔡娜莉[1] 

机构地区：[1]广东医学院附属医院儿科,湛江524001

出　　处：《中国新生儿科杂志》2008年第5期261-264,共4页Chinese Journal of Neonatology

摘　　要：目的了解本院近10年来新生儿败血症病原菌及其耐药性变迁,以指导临床用药。方法对1997年3月至2002年3月收治的新生儿败血症(第1组)血培养检出菌、药敏试验结果进行回顾性调查,并与2002年4月至2007年3月的调查结果(第2组)进行比较。结果10年来新生儿败血症血培养阳性的患儿296例,第1组155例,第2组141例,病原菌以革兰阳性细菌为主,近5年来凝固酶阴性葡萄球菌(CNS)感染率明显增加(χ2=14.15,P<0.01),金葡菌感染率显著下降(χ2=10.88,P<0.01),对青霉素、苯唑西林及红霉素有较高的耐药率,多重耐药较明显,耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)及耐甲氧西林的金葡菌(MRSA)感染增多,对万古霉素敏感性较高。革兰阴性杆菌对氨苄西林普遍耐药,对亚胺培南、氨曲南高度敏感,对氨基糖甙类、喹诺酮类及三代头孢菌素敏感性较高,但耐药菌株有增加的趋势。结论CNS是本院新生儿败血症最主要的病原菌,对青霉素等常用抗生素普遍耐药,多重耐药菌株增加,根据病原菌药敏结果合理使用抗生素,是有效抗感染和延缓耐药菌株产生的必要条件。Objective To study the changes of patterns of pathogens and their drug resistances of neonatal septicemia in last 10 years in our hospital to provide clinical guidance of antibiotic usage. Methods The infants diagnosed with neonatal septicemia were assigned into two groups according to the time they were admitted and treated, from 1997 to March 2002 （ group Ⅰ ） and from April 2002 to March 2007 （group Ⅱ ） ; the blood culture results and their drug sensitivities were retrospectively analyzed. Results In last 10 years, there were 296 cases of positive blood culture, 155 cases in group Ⅰ and 141 cases in group Ⅱ. Among the ＇positive cultures, it was found that Gram-positive cocci were the main pathogen of neonatal septicemia, the incidence of coagulase negative staphylococcus （CNS） infection increased significantly （χ^2 = 14. 15, P 〈 0. 01 ） and the incidence of staphylococcus aureus infection declined significantly （χ^2 = 10. 88 ,P 〈0. 01 ） in recent 5 years, the pathogens showed high resistance to penicillin, oxacillin, erythromycin and multidrug resistances; it was also found that the incidence of methicillin resistant coagulase negative staphylococcus （MRCNS） and methicillin resistant staphylococcus aureus （MRSA） increasing, the pathogens showed high sensitivity to vancomycin. Gram-negative bacillus were found widespread resistant to ampicillin, highly sensitive to imipenem and aztreonam and also sensitive to aminoglycosides, quinolones and third generation cephalosporins; but drug resistant strains showed increased tendency. Conclusion CNS was found to be the main pathogen causing neonatal septicemia in our hospital, it showed high resistance to penicillin and other commonly used antibiotics with increasing muhidrug resistant tendency. It is imperative to choose antibiotics according to result of drug sensitive test to decrease or delay the occurrence of drug resistance when treating neonatal septicemia.

关 键 词：细菌感染 病原 抗药性 多药 

分 类 号：R722.1[医药卫生—儿科]