基于新生儿临床抗感染治疗与细菌变迁的影响  

Effect of Bacterial Changes on Anti-infection Therapy in Neonates

作　　者：肖艳[1] 米弘瑛[2] 胡建英 刘宇 XIAO Yan;MI HongYing;HU Jian Ying;LUU Yu(Dept.of Stomatology,The First People's Hospital of Yunnan Province,Kunming Yunnan 650032;Dept.of Pediatrics,The First People's Hospital of Yunnan Province,Kunming Yunnan 650032;Dept.of Pharmaceutical,The First People's Hospital of Yunnan Province,Kunming Yunnan 650032;College of Pharmacy and Chemistry,Dali University,Dali Yunnan 671000,China)

机构地区：[1]云南省第一人民医院口腔科,云南昆明650032 [2]云南省第一人民医院儿科,云南昆明650032 [3]云南省第一人民医院药学部,云南昆明650032 [4]大理大学药学与化学学院,云南大理671000

出　　处：《昆明医科大学学报》2020年第1期73-79,共7页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2017FE468-166);云南省卫计委内设研究机构基金资助项目(2016NS236)。

摘　　要：目的了解云南省第一人民医院儿科2014年1月至2017年12月新生儿患儿病原菌随时间区域的变迁规律、感染分布特点及耐药性情况,以期为临床合理应用提供参考。方法回顾性分析云南省第一人民医院儿科504例患儿临床病例资料及其痰、血液、导管及尿液等标本,分析病原菌特点和抗菌药物耐药性情况。结果504例患儿标本共分离出致病菌612株,以革兰阴性杆菌为主,375株(61.3%),其中大肠埃希菌最多见,肺炎克雷伯菌、鲍曼不动杆菌其次;革兰氏阳性菌以表皮葡萄球菌为多,224株(36.6%),其次为溶血葡萄球菌。感染主要为新生儿肺部感染,共420例,占68.63%,以革兰阴性杆菌居多。感染部位不同致病菌特点不同,痰液275株(44.93%)、血液156株(25.49%)以革兰氏阴性菌为主,导管102株(16.67%)以革兰氏阳性菌为多。时间区间不同病原菌存在差异,2016年期间,产ESBL、不产ESBL肺炎克雷伯菌的耐药率高达80%以上,使得治疗无效例数增加,应重点关注时间区域中病原菌耐药特性。结论2014~2017年新生儿感染病原菌谱变化不大,前3位均为大肠埃希菌、表皮葡萄球菌和肺炎克雷伯菌。新生儿感染主要为肺部感染,以革兰氏阴性菌居多,并应重点关注感染部位致病菌特点及时间区域中病原菌耐药特性。Objective To understand the changes of pathogens,infection distribution and drug resistance of newborn patients in our hospital from 2014 to 2017,in order to provide reference for clinical rational application.Methods Clinical case data of 504 newborn patients in our hospital were retrospectively analyzed,including sputum,blood,catheter and urine,the characteristics of pathogens and antibiotic resistance were analyzed.Results A total of 612 pathogenic bacteria were isolated from 504 newborn patients,mainly G-bacteria,375(61.3%),of which escherichia coli was the most common,followed by klebsiella pneumoniae and acinetobacter baumannii;the most G+bacteria were staphylococcus epidermidis(224 strains,36.6%),followed by hemolytic staphylococcus.The main infection was pulmonary infection in neonates,which was 420 cases(68.63%).Different pathogenic bacteria have different characteristics at the infected site,between 275 strains of sputum(44.93%)and 156 strains of blood(25.49%),G-bacteria were the main strains.In 102 strains of catheter(16.67%),G+bacteria were the most common.There were differences in pathogenic bacteria in different time intervals.During 2016,the drug resistance rate of klebsiella pneumoniae producing ESBL or not producing ESBL was as high as 80%,leading to an increase in the number of cases of treatment failure.Therefore,it was necessary to focus on the characteristics of pathogen resistance in time regions.Conclusions From 2014 to 2017,the pathogen spectrum of neonatal infection has not changed much,and the first three are all escherichia coli,staphylococcus epidermidis and klebsiella pneumoniae.Neonatal infections are mainly pulmonary infections,mostly Gram-negative bacteria,and we should focus on the characteristics of pathogenic bacteria at the site of infection and the resistance characteristics of pathogens in the time zone.

关 键 词：新生儿 早产儿 细菌感染 病原菌 耐药性 

分 类 号：R722.13[医药卫生—儿科]