早产儿与足月儿败血症病原学分布特点及耐药分析  

Pathogenic distribution and drug resistance analysis of neonatal septicemia in preterm and full-term infants

作　　者：成大欣[1,2] 康华[1] 蔚永青[1] 李琛[1] 王宇娜[1] CHENG Da-xin;KANG Hua;WEI Yong-qing;LI Chen;WANG Yuna(Department of Neonatology,Shaanxi Provincial People＇s Hospital,Shaanxi Xi＇an 710068,China;Research Institute of Atherosclerotic Disease and Lipid Metabolism,Cardiovascular Research Center,Xi＇an diaotong University,Shaanxi Xi＇an 710061,China)

机构地区：[1]陕西省人民医院新生儿科,陕西西安710068 [2]西安交通大学心血管研究中心动脉硬化与脂代谢实验室,陕西西安710061

出　　处：《中国妇幼健康研究》2018年第9期1071-1076,共6页Chinese Journal of Woman and Child Health Research

基　　金：陕西省自然科学基金和卫生厅资助项目(2016JM8061;2014D38)

摘　　要：目的探讨早产儿与足月儿败血症病原菌分布特点及耐药规律,为临床合理用药、降低新生儿败血症死亡率提供理论依据。方法收集2014年1月1日至2016年12月31日确诊为败血症的新生儿临床资料,将这些新生儿分为早产儿败血症组(127例,简称早产儿组)与足月儿败血症组(41例,简称足月儿组),比较两组的构成比、病死率、病原菌分布及耐药率差异。结果早产儿败血症占同期住院早产儿的4.43%(127/2 861),显著高于足月儿组1.34%(41/3 057)(χ2=51.42,P<0.05);早产儿组与足月儿组病死率比较无明显差异(5.51%vs.7.32%,P>0.05)。检出引起败血症前五位病原菌依次为肺炎克雷伯菌、大肠埃希菌、表皮葡萄球菌、光滑假丝酵母菌、高里氏假丝酵母菌。革兰阴性菌检出率最高(57.74%),真菌检出率最低(19.64%)。早产儿组真菌检出率高于足月儿组(25.2%vs.2.4%,P=0.001),足月儿组革兰阳性菌检出率高于早产儿组(34.2%vs.18.9%,χ2=4.12,P<0.05)。葡萄球菌、肺炎克雷伯菌、大肠埃希菌的产酶率在早产儿组与足月儿组中均较高(分别为92.9%vs.70.0%、64.7%vs.53.3%、30%vs.44.4%),耐药率也较高,两组比较均无统计学差异(均P>0.05)。利奈唑胺、万古霉素、替考拉宁、达托霉素、阿米卡星、美罗培南尚未发现耐药菌株。结论定期分析早产儿与足月儿败血症病原菌分布差异及耐药规律,可为临床合理用药,减少耐药菌株产生,降低新生儿败血症死亡率提供一定的依据。Objective To explore the distribution characteristics and drug resistance of pathogenic bacteria in preterm and full-term infants and to provide a theoretical basis for clinical rational drug use and reducing neonatal sepsis mortality.Methods Clinical data of neonates diagnosed with sepsis from January 1,2014 to December 31,2016 were collected.These neonates were divided into preterm infants with septicemia group（127 cases,referred to as preterm infants group）and full-term infants with septicemia group（41 cases,referred to as full-term infants group）.The constituent ratios,mortality,pathogen distributions and drug resistance rates of two groups were compared.Results The preterm infants with septicemia accounted for 4.43% of the hospitalized preterm infants,which was significantly higher than 1.34% in full-term infants（χ2=51.42,P〈0.05）,and there was no significant difference in mortality between preterm infants group and full-term infants group（5.51% vs 7.32%,P〉0.05）.The first five pathogens causing sepsis were Klebsiella pneumoniae,Escherichia coli,Staphylococcus epidermidis,Candida glabrata and Candida gallicans.The detection rate of Gram-negative bacteria was highest（57.74%）and that of fungi was lowest（19.64%）.The detection rate of fungi in preterm infants group was higher than that in full-term infants group（25.2% vs.2.4%,P=0.001）,and detection rate of Gram-positive bacteria in full-term infants group was higher than that in preterm infants group（34.2%vs.18.9%,χ2=4.12,P〈0.05）.Staphylococcus,Klebsiella pneumoniae and Escherichia coli had higher enzyme production rates（92.9% vs.70.0%,64.7% vs.53.3%,and 30% vs.44.4%,respectively）and higher drug resistance rates in preterm infants group and full-term infants group,and there was no significant difference between two groups（all P〉0.05）.Drug-resistant strains of linezolid,Vancomycin,Teicoplanin,Daptomycin,Ami Amikacin and Meropenem were not been found.Conclusion Regular analysis of the pathogenic distribution and drug

关 键 词：败血症 早产儿 足月儿 耐药性 

分 类 号：R722.131[医药卫生—儿科]