新生儿产超广谱β-内酰胺酶菌感染临床及耐药性分析  

Analysis of clinical manifestations and drug resistance of extended-spectrum beta-lactamase producing bacteria infection in neonates

作　　者：孙利伟[1] 杜克凝[1] 田玉玲[1] 宇亚娟[1] 刘愉[1] Hong Yin 李丽红[1] 

机构地区：[1]长春市儿童医院,吉林长春130051 [2]瑞典林学平大学医院,瑞典58185

出　　处：《临床儿科杂志》2013年第3期209-212,共4页Journal of Clinical Pediatrics

摘　　要：目的了解新生儿产ESBLs菌感染率,分析产ESBLs菌阳性新生儿的临床表现及耐药情况。方法于2011年1月至12月采集住院新生儿鼻咽拭子和粪便标本进行细菌培养、药敏试验及ESBLs菌阳性新生儿的临床表现分析。结果 2011年1月至12月住院新生儿入院当天鼻咽拭子中ESBLs菌检出率为10.99%;入院72 h后阳性率29.82%。粪便标本入院当天ESBLs菌检出率为52.66%;入院72 h后阳性率为70.81%。ESBLs菌阳性新生儿平均年龄(14.37±7.63)d,男女之比为1.9:1。入院72 h后34例鼻咽拭子ESBLs菌阳性新生儿100%存在感染,50%伴有新生儿黄疸,50%为早产儿。148例粪便标本ESBLs菌阳性新生儿80%存在感染,20%为新生儿腹泻病,40%伴有新生儿黄疸,10.32%为早产儿。全部新生儿平均住院天数为(18.13±8.64)d。入院当日鼻咽部ESBLs菌检测阳性新生儿使用抗生素比率为30%(9/30)较ESBLs菌阴性新生儿使用抗生素比率5.76%(14/243)明显增高,差异有统计学意义(χ2=17.314,P=0.000);粪便标本入院当日和入院72 h后ESBLs菌检测阳性新生儿较阴性新生儿抗生素使用率和第三代头孢菌素使用率均明显升高,差异均有统计学意义(P均<0.001);ESBLs阳性菌对头孢噻肟/克拉维酸(CTX/CA)、亚胺培南敏感,对头孢噻肟、头孢他啶、头孢曲松、头孢呋辛、头孢吡肟、头孢唑林、氨苄西林、氨曲南明显耐药。结论部分新生儿咽部和粪便中存在ESBLs菌;住院新生儿容易出现ESBLs菌院内感染;Objective To find out the rate of extended-spectrum beta-lactamase（ESBLs） producing bacterial infection,and to analyze its clinical manifestations and drug resistance in newborns.Methods Nasopharyngeal swab specimens and fecal samples of newborns were collected in hospital from January to December in 2011 and the bacterial culture and susceptibility test were performed.The clinical manifestations of ESBLs-producing bacteria infection in neonates were analyzed.Results For nasopharyngeal swab specimens,the detection rate of ESBLs-producing bacteria was 10.99% on the admission day,and 29.82% at 72 hours after admission.For fecal samples,the detection rate was 52.66% on the admission day,and 70.81% at 72 hours after admission.The age of ESBLs positive neonates was 14.37±7.63 days,and boy-to-girl ratio was 1.9：1.The infection existed in 100% neonates with positive ESBLs from nasopharyngeal swab,among whom 50% had jaundice,and 50% were premature.The infection existed in 80% neonates with positive ESBLs in feces,among whom 20% had diarrhea,40% had jaundice and 10.32% were premature.The average length of hospital stay was 18.13±8.64 days.The rate of antibiotic application in ESBLs positive neonates was 30%（9/30）.However,the rate of antibiotic application in ESBLs negative neonates was 5.76%（14/243）（χ2=17.314,P=0.000）.The rate of antibiotic application and third generation cephalosporin application were increased significantly in neonates with ESBLs detected in stool specimen（P0.001）.The ESBLs-producing bacteria were sensitive to cefotaxime/clavulanic acid（CTX/CA） and imipenem,but resistance to Cefotaxime,Ceftazidime,Ceftriaxone,Cefuroxime,Cefepime,Cefazolin,Ampicillin and Aztreonam.Conclusions ESBLs exists in the pharynx and the feces in some newborns,and hospitalized neonates are easy to be infected with ESBLs.The selective pressure of antibiotic is the risk factor for generation of ESBLs-producing bacteria.

关 键 词：临床研究 超广谱Β-内酰胺酶 耐药性 新生儿 

分 类 号：R446.5[医药卫生—诊断学]