新生儿败血症病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens isolated from neonates with septicemia

作　　者：贾忠兰[1] 毕福玲 张彩明[1] 

机构地区：[1]北京市海淀区妇幼保健院检验科,北京100080

出　　处：《中华医院感染学杂志》2017年第1期197-200,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨新生儿败血症病原菌的分布及耐药状况,为临床诊治新生儿败血症提供依据。方法回顾性分析2010年1月-2015年12月医院1 905例新生儿血培养病原菌分布和对抗菌药物的耐药性,进行统计分析。结果 1 905例新生儿中有165例血培养阳性,阳性率为8.7%,共分离出168株病原菌,3例败血症患儿出现复合菌感染;病原菌以革兰阴性菌为主,93株占55.4%,革兰阳性菌73株占43.4%,真菌2株占1.2%;革兰阴性菌以大肠埃希菌和肺炎克雷伯菌为主,两种致病菌对含β-内酰胺酶抑制剂的复合制剂、碳青霉烯类抗菌药物敏感率较高,可作为首选药;革兰阳性菌以表皮葡萄球菌、无乳链球菌和金黄色葡萄球菌为主,葡萄球菌属对青霉素高度耐药,耐甲氧西林金黄葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRSCON)的检出率分别为33.3%和86.4%,二者均表现为多药耐药,可选用万古霉素治疗,无乳链球菌和产单核李斯特菌对青霉素类高度敏感,治疗其引起的新生儿败血症首选青霉素类抗菌药物。结论医院新生儿败血症患儿分离的病原菌中革兰阴性菌多于革兰阳性菌,真菌感染较少见,新生儿败血症的治疗应该根据病原菌的种类和对抗菌药物的耐药性特点及早合理治疗,特别注重无乳链球菌和产单核李斯特菌的治疗,能有效降低新生儿的病死率。OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from neonates with septicemia so as to provide guidance for treatment of the neonates with septicemia. METHODS From Jan 2010 to Dec 2015, the distribution and drug resistance of pathogens cultured from blood of 1 905 neonates were retrospec- tively analyzed, and the statistical analysis was performed. RESULTS Of the 1 905 neonates, 165 were blood cul- ture-positive, with the positive rate 8.7Y0. A total of 168 strains of pathogens were isolated, and 3 septicemia chil- dren had complex bacteria infections. Among the isolated pathogens, there were 93 （55.4%） strains of gram-nega- tive bacteria, 73 （43.7%） strains of gram-positive bacteria, and 2 （1.2%） strains of fungi. Escherichia coli and Klebslella pneumoniae were the predominant species of gram-negative bacteria and were highly susceptible to com- binations containing beta-lactamase inhibitors and carbapenems, which could be used as the preferred drugs. Staphylococcus epiderrnidis, Streptococcus agalactiae, and Staphylococcus aureus were dominant among the gram-positive bacteria, the S. aureus strains were highly resistant to penicillin, the isolation rates of methicillin-re- sistant aureus （MRSA） and methicillin-resistant coagulase-negative Staphylococcus （MRSCON） were 33.3% and 86.4%, the two species showed multidrug-resistant and could be treated with vancomycin. L. monocytogenes and monocytogenes-producing Listeria were highly susceptible to penicillins, which could be used as the preferred drugs for treatment of the neonates with septicemia induced by the two species. CONCLUSION Among the patho- gens isolated from the neonates with septicemia, the gram-negative bacteria are more than the gram-positive bacte- ria, and the fungi are rarely isolated. It is necessary to conduct early and reasonable treatment of the neonates with septicemia based on the species of pathogens and characteristics of drug resistance, especially the treatment of S. agalactiae and L. m

关 键 词：新生儿败血症 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]