3个月龄以内婴儿败血症病原菌分布及抗菌药物耐药状况分析  

Pathogen distribution and antibiotic resistance in infants with sepsis up to the age of 3 months

作　　者：徐晓明 付捷[1] 高坎坎[1] 朱素菲 曾兰兰[1] 庄晓旭 高秀蓉 高飞[1] 龙燕[1] 刘海英[1] Xu Xiaoming , Fu Jie , Gao Kanlean , Zhu Sufei , Zeng Lanlan , Zhuang Xiaoxu , Gao Xiurong , Gao Fei, Long Yah, Liu Haiying.(Department of Clinical Laboratory, Guangzhou Women and Children＇ s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, Chin)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心检验科,510623

出　　处：《中华妇幼临床医学杂志（电子版）》2018年第2期186-192,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：广东省科技厅社会发展领域项目(2014A020212520);广州市科技创新委员会科技创新发展专项资金项目(201807010182)~~

摘　　要：目的探讨月龄<3个月婴儿败血症的病原菌分布[排除凝固酶阴性葡萄球菌(CNS)]及其对抗菌药物耐药状况。方法选择2012年1月1日至2016年12月31日,广州医科大学附属广州市妇女儿童医疗中心收治的924例月龄<3个月的婴儿败血症患儿为研究对象。这924例患儿经血培养,共计分离出968株病原菌。回顾性分析924例月龄<3个月的婴儿败血症患儿的病原菌分布情况,早发型败血症(EOS)与晚发型败血症(LOS)患儿病原菌分布情况,以及常见革兰阴性杆菌、革兰阳性球菌对抗菌药物耐药情况。采用χ~2检验,对EOS和LOS患儿血培养分离出的大肠埃希菌、肺炎克雷伯菌、B族链球菌(GBS)、金黄色葡萄球菌、真菌所占比例进行比较。本研究遵循的程序符合广州医科大学附属广州市妇女儿童医疗中心医学伦理委员会制定的伦理学标准,并得到该委员会审查批准。结果 (1)本研究924例月龄<3个月的婴儿败血症患儿血培养共计分离出968株病原菌,其中革兰阴性杆菌为593株(61.3%,593/968),以大肠埃希菌(21.4%,207/968),肺炎克雷伯菌(19.6%,190/968)为主;革兰阳性球菌为318株(32.9%,318/968),以GBS(11.5%,111/968),金黄色葡萄球菌(7.7%,75/968),粪肠球菌(4.1%,40/968)为主;真菌为52株(5.4%,52/968);革兰阴性球菌为3株(0.3%,3/968);革兰阳性杆菌为2株(0.2%,2/968)。(2)197例EOS患儿血培养共计分离出226株病原菌,常见病原菌前3位依次为大肠埃希菌(23.9%,54/226),GBS(17.7%,40/226)和肺炎克雷伯菌(15.9%,36/226)。727例LOS患儿血培养共计分离出742株病原菌,常见病原菌前3位依次为肺炎克雷伯菌(20.8%,154/742),大肠埃希菌(20.6%,153/742)和GBS(9.6%,71/742)。EOS患儿血培养分离出的GBS所占比例为17.7%(40/226),明显高于LOS患儿的9.6%(71/742),二者比较,差异有统计学意义(χ~2=11.280,P=0.001)。EOS患儿血培养分离出的金黄色葡萄球菌及真菌所占比例分别为4.0%(9/226)与2.7%(6/226),均分别低于Objective To investigate the pathogen distribution with coagulase negative staphylococcus（CNS）excluded and antibiotic resistance of infants with sepsis during the first3 months after birth.Methods A retrospective analysis was conducted on 968 isolates from 924 infants within 3 months of age who were admitted to the Guangzhou Women and Children′s Medical Center,Guangzhou Medical University from January 1,2012 to December 31,2016.The following items were analyzed,including pathogen distribution of 968 isolates from 924 infants within 3 months of age and with blood culture-confirmed sepsis,pathogen distribution of early-onset sepsis（EOS）infants and late-onset sepsis（LOS）infant,and antibiotic resistance of common Gram-negative bacilli and Gram-positive cocci.Chi-square test was taken to compare the constituent ratio of Escherichia coli,Klebsiella pneumoniae,group Bstreptococci（GBS）,Staphylococcus aureus,and fungi isolated from blood culture-confirmed sepsis between EOS and LOS infants.The procedures followed in this study were in line with the ethical standards established by the Medical Ethics Committee of the Guangzhou Women and Children′s Medical Center,Guangzhou Medical University and were reviewed and approved by the committee.Results（1）Among 968 isolates from 924 infants within 3 months of age,Gram-negative bacilli were predominant（593 strains,61.3%,593/968）,followed by Grampositive cocci（318 strains,32.9%,318/968）,fungi（52 strains,5.4%,52/968）,Gram-negative cocci（3 strains,0.3%,3/968）and Gram-positive bacilli（2 strains,0.2%,2/968）.Escherichia coli（21.4%,207/968）and Klebsiella pneumoniae（19.6%,190/968）were the main pathogens of Gramnegative bacilli. And GBS（11.5%,111/968）, Staphylococcus aureus（7.7%,75/968）,Enterococcus faecalis（4.1%,40/968）were the main pathogens of Gram-positive cocci.（2）A total of226 isolates were isolated from 197 EOS infants,of which the predominant pathogens were Escherichia coli（23.9%,54/226）,GBS（17.7%,40/226）and

关 键 词：脓毒症 病原菌 抗菌药 抗药性 细菌 抗药性 真菌 婴儿 

分 类 号：R446.5[医药卫生—诊断学] R725.1[医药卫生—临床医学]