新生儿重症监护室血培养233株病原菌分布及耐药性分析  

Analysis of distribution and antibiotic resistance of 233 positive results of blood cultures in neonatal intensive care unit

作　　者：叶巧云[1] 林湛[2] 敖当[3] 黄宇戈[3] 

机构地区：[1]湛江市遂溪县人民医院儿科,524300 [2]广东医学院附属医院细菌室,湛江524000 [3]广东医学院附属医院新生儿区,湛江524000

出　　处：《中国小儿急救医学》2012年第4期396-398,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的研究新生儿重症监护室（neonatalintensivecareunit，NICU）血培养阳性的脓毒症患儿的病原菌分布及耐药情况，为临床合理使用抗生素提供依据。方法回顾性分析2009年1月至2011年7月广东医学院附属医院NICU1450例新生儿的1450份血培养结果及药敏结果。结果1450份血培养标本共分离病原菌9种233株，总阳性率为16．1％。其中革兰阳性球菌93株，以凝固酶阴性葡萄球菌占优势，其次为金黄色葡萄球菌；革兰阴性杆菌103株，以肺炎克雷白杆菌居多，其次为大肠埃希菌、鲍曼不动杆菌；真菌37株，以念珠菌为主。革兰阳性球菌对万古霉素、利奈唑胺及替考拉宁敏感性高，对青霉素、苯唑西林及β-内酰胺酶抗生素耐药性达95％以上；革兰阴性杆菌对左氧氟沙星、亚胺培南及美罗培南敏感；真菌以念珠菌为主，对抗真菌药物普遍敏感。结论凝固酶阴性葡萄球菌、肺炎克雷白杆菌、大肠埃希菌等是NICU中新生儿脓毒症最常见的几种病原菌，耐药性高，临床医生应根据细菌鉴定及药敏试验选择敏感药物治疗，且真菌感染不可忽视，值得关注。Objective To investigate the pathogens distribution and their drug resistance of blood culture-positive neonates with sepsis in neonatal intensive care unit（NICU） and to provide evidence for clini- cally reasonable use of antibiotics. Methods One thousand four hundred and fifty neonates admitted to our NICU of Affiliated Hospital of Guangdong Medical College from Jan 2009 to Jul 2011 were enrolled. The blood samples from 1 450 neonates were cultured and isolated, and all of the isolates and their resistances were analyzed retrospectively. Results A total of 9 species and 233 pathogenic strains were isolated from 1 450 specimens, and the positive rate was 16. 1%. Among the 233 strains ,93 strains were gram-positive coc- ci, 103 strains were gram-negative bacilli, and 37 strains were fungus. Among gram-positive cocci, the most dominant organism was coagulase negative staphylococcus, the next was Staphylococcus aureus;while among gram-negative bacilli, Klebsiella pneumoniae were the most frequently isolated, the next were Escherichia coli and Acinetobacter baumannii, and among the fungus, monilia were the most isolated. The resistance rates of gram-positive cocci to vancomycin, linezolid and teicoplanin were high. Moreover, the antibiotic resistance rates to penicillin, oxazocilline and the [3-1actamase were more than 95 %. Gram-negative bacilli were sensi- tive to levofloxacin, imipenem and meropenem. A majority of fungus was Monilia, which was sensitive to an- tifungal. Conclusion Coagulase negative staphylococcus, Klebsiella pneurnoniae and Escherichia coli are the the most common pathogens of neonatal sepsis in NICU, and have high drug resistance. Clinicians should se- lect sensitive drug treatment according to bacterial identification and susceptibility testing. Besides, mycotic infection cannot be ignored and merit our attention.

关 键 词：药物耐受性 病原菌 婴儿 新生 

分 类 号：R446.5[医药卫生—诊断学]