综合性医院新生儿败血症临床特点及耐药性分析  

Analysis of Clinical Features and Pathogen Drug Resistance of Neonatal Septicemia in General Hospital

作　　者：林亚芬[1] 金永红[1] 李春燕[1] 张铮铮[1] 陈碧琴[1] 

机构地区：[1]复旦大学附属金山医院儿科,上海200540

出　　处：《中国临床医学》2009年第5期769-771,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨新生儿败血症的临床表现、致病菌、G+葡萄球菌耐药性,早期诊断及合理应用抗菌药物。方法:用法国梅里3位的临床表现为黄疸、呼吸道症状、体温改变,第4位为纳差、反应差,早发型以早产、呼吸道症状及纳差为主要表现,晚发型以黄疸,呼吸道、消化道症状,体温改变为主要表现。检出凝固酶阴性葡萄球菌(CBS)43例(占79.6%),大肠埃希菌5例(9.3%),金黄色葡萄球菌4例(占7.4%),鲍曼不动杆菌2例(占3.7%),阴沟杆菌1例(占1.9%)。凝固酶阴性葡萄球菌对青霉素、红霉素的耐药率达86%及60.5%,金黄色葡萄球菌对青霉素100%耐药,对红霉素、新霉素50%耐药,耐甲氧西林的表皮葡萄球菌(MRSE),耐甲氧西林的金黄色葡萄球菌(MRSA)分别为43%及50%,对MRSA、MRSE引起的严重感染在对β-内酰胺类抗生素高度耐药的情况下万古霉素为首选。结论:根据新生儿生后不同时期败血症的不同的临床表现及早进行病原菌的检测,根据血培养药敏试验,合理用抗生素可减少细菌的耐药性,提高疗效。Objective：To study the neonatal septicemia clinical features, pathogen and gram positive staphylococcus drug resistance to find neonatal septicemia early and guide clinical reasonable selection and application of antibiotics. Methods：Bacteria culture （including blood culture medium and culture incubator） and the strip for drug sensitive test is supplied by French Bi omerieux and British DXID, respectively. Results： Jaundice, respiratory symptom and altering body temperature were the top three clinical manifestation of neonatal septicemia, while anorexia and low response were ranked fourth. Early onset mainly presented premature, respiratory symptom and anorexia; late onset mainly presented jaundice, respiratory symptom, digestive symptom and altering body temperature. The cultured bacteria of coagulase negative staphylococcus, Escherichia colt, Staphy- lococcus aureus, Acinetobacter baumanii and Enterobacter cloacae accouted for 79.6%（43 cases）, 9.3%（5cases）, 7.4%（4 cases）, 3.7% （2 cases） and 1.9 % （1 cases）, respectively. Penicillin and erythromycin resistant rates of coagulase negative staphy- lococcus were 86%and 60. 5%, respectively. Penicillin, erythromycin and neomycin resistant rates of staphylococcus aureus was 100%and 50%, respectively. Methillin resistant rate of staphylococcus epidermidis （MRSE） and staphylococcus aureus （MRSA） was 44.2% and 50%, respectively. Vancomycin was the fisrt choice for severe infection caused by MRSE, MRSA and β-lactamase highly resistant bacteria. Conclusion： Based on different clinical features of neonatal septicemia over time, path ogenic bacteria should be detected early. And according to blood culture and drug sensitive test, we can select and apply antibi otics reasonably to reduce drug resistance and improve clinical treatment effects.

关 键 词：新生儿 败血症 临床表现 病原菌 药敏试验 

分 类 号：R722.131[医药卫生—儿科]