早产极、超低出生体重儿导管定植菌的临床分析  

Clinical analysis on catheter colonized bacteria in very and extremely low birth weight premature infants

作　　者：曾淑娟[1] 温伟溪 谭万彩 邬吉伟 张佳彬[1] 王慧娟[1] 史林东[1] 丘惠娴[1] 

机构地区：[1]深圳市龙岗中心医院新生儿科,广东深圳518116

出　　处：《中国妇幼保健》2017年第2期280-283,共4页Maternal and Child Health Care of China

基　　金：广东省深圳市龙岗区科技创新局资助项目(201406063001034)

摘　　要：目的了解早产极、超低出生体重儿导管定植菌的分布及耐药情况。方法选择在深圳市龙岗中心医院产科出生后立即转入本院新生儿科住院时间≥14 d的70例早产极、超低出生体重儿为研究对象,在拔除或更换气管导管及PICC或脐动静脉导管时常规留导管头培养进行细菌学监测,详细收集每位患儿的临床及实验室资料,对结果进行统计学分析。结果 70例患儿共送检标本150份,其中PICC导管末端55份,脐静脉导管末端30份,脐动脉导管末端15份,气管导管末端50份。共培养出20株定植菌,其中革兰阳性球菌8株,包含表皮葡萄球菌3株,金黄色葡萄球菌2株,屎肠球菌2株,链球菌1株;革兰阴性杆菌12株,包括肺炎克雷伯杆菌5株,大肠杆菌4株,粘质沙雷杆菌1株,鲍曼不动杆菌1株,嗜麦芽窄食假单胞菌1株。70例患儿住院期间出现新生儿血流感染共7例,占10.0%;血培养阳性3例,其中2例为葡萄球菌,1例为大肠埃希菌。感染菌与定植菌一致。结论本院早产极、超低出生体重儿导管主要定植菌为肺炎克雷伯杆菌、大肠埃希菌及葡萄球菌,与新生儿血流感染菌一致。故应对在NICU住院的早产儿进行细菌学监测,根据监测结果判断细菌定植状态并采取有限保护措施,加强管道管理,合理使用抗生素,缩短住院时间和胃肠外营养的时间,对控制早产儿细菌定植将起到重要作用。Objective To understand the distribution and drug resistance of catheter colonized bacteria in very and extremely low birth weight premature infants. Methods Seventy very and extremely low birth weight premature infants who were born in Department of Obstetrics in the hospital and transferred to Department of Neonatalogy for 14 days or more than 14 days were selected,bacterial culture of catheters was conducted when pulling or replacing endotracheal tubes or PICC or umbilical catheters,the clinical and laboratory data of each infants was collected in detail,the results were statistically analyzed. Results A total of 150 specimens from 70 premature infants were obtained and examined,including 55 specimens from PICC catheters,30 specimens from umbilical vein catheters,30 specimens from umbilical artery catheters and 50 specimens from endotracheal tubes. Finally,20 bacterial strains were cultured,including 8 strains of Gram-positive coccus（ 3 strains of Staphylococcus epidermidis,2 strains of Staphylococcus aureus,2 strains of Enterococcus faecalis,and 1 strain of Streptococcus）and 12 strains of Gram-negative bacilli（ 5 strains of Klebsiella pneumoniae,4 strains of Escherichia coli,1 strain of Serratia marcescens,1strain of Acinetobacter baumanii,1 strain of Stenotrophomonas maltophilia）. Among 70 infants,7 infants were diagnosed as neonatal blood stream infection,accounting for 10. 0%; 3 infants were found with positive blood culture result,including two infants with Staphylococcus aureus infection and one infant with Escherichia coli infection. Infected bacteria were consistent with colonized bacteria. Conclusion The main catheter colonized bacteria in very and extremely low birth weight premature infants from the hospital are Klebsiella pneumonia,Escherichia coli,and Staphylococcus aureus,which are in accordance with bacteria inducing neonatal blood stream infection. Bacterial monitoring should be conducted among the premature infants in NICU,bacterial colonization status can be determined according to th

关 键 词：早产 极低出生体重儿 超低出生体重儿 细菌定植 导管 

分 类 号：R722[医药卫生—儿科]