凝固酶阴性葡萄球菌致新生儿败血症病原学及青霉素联合万古霉素治疗效果分析  

Etiology of neonatal sepsis caused by coagulase-negative Staphylococci and therapeutic effect of penicillin combined with vancomycin

作　　者：赵杰 朱萍[1] 苌俊明 别静洋[1] 李德亮[1] 王海云 杨柳[1] ZHAO Jie;ZHU Ping;CHANG Junming;BIE Jingyang;LI Deliang;WAMG Haiyun;YANG Liu(Neonatal Intensive Care Unit,Nanyang Central Hospital/Nanyang Central Hospital Affiliated to Zhengzhou University,Nanyang 473005,Henan Province,China)

机构地区：[1]南阳市中心医院/郑州大学附属南阳中心医院新生儿重症监护病区,河南南阳473005

出　　处：《新乡医学院学报》2022年第7期673-679,共7页Journal of Xinxiang Medical University

摘　　要：目的探讨凝固酶阴性葡萄球菌(CNS)致新生儿败血症的病原菌分布和耐药性,以及青霉素联合万古霉素治疗CNS致新生儿败血症的疗效。方法选择2019年1月至2020年12月南阳市中心医院收治的CNS致新生儿败血症185例为研究对象,根据治疗方法将患儿分为观察组(n=94)和对照组(n=91)。对照组患儿给予注射用青霉素钠静脉滴注,每次50000 U·kg^(-1),出生7 d内每12 h 1次,出生第7天后每8 h 1次。观察组在对照组基础上给予万古霉素治疗,第1天给予15 mg·kg^(-1)万古霉素静脉滴注,滴注时间﹥1 h,每日1次;第2天开始给予10 mg·kg^(-1)万古霉素静脉滴注,滴注时间﹥1 h,每日1次。2组患儿均治疗14 d。采用全自动细菌鉴定及药物敏感分析系统进行菌种鉴定和药物敏感性分析,按照《抗菌药物临床研究指导原则》评定临床疗效,应用流式细胞仪检测全血自然杀伤(NK)细胞活性,应用全自动血液细胞分析仪进行白细胞(WBC)计数,应用全自动生物化学分析系统检测血清免疫球蛋白(Ig)G、IgM水平,采用酶联免疫吸附法检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8、C反应蛋白(CRP)水平。结果185例CNS致新生儿败血症患儿的病原菌前3位分别为表皮葡萄球菌、溶血葡萄球菌、人葡萄球菌,占比分别为40.54%(75/185)、28.11%(52/185)、14.05%(26/185)。表皮葡萄球菌对青霉素、氨苄西林、苯唑西林的耐药性分别为100.00%、97.33%、92.00%,对替考拉宁、万古霉素的敏感性均达100.00%;溶血葡萄球菌对青霉素、氨苄西林、苯唑西林、头孢曲松、红霉素的耐药性分别为100.00%、100.00%、96.15%、94.23%、92.31%,对替考拉宁、万古霉素的敏感性均达100.00%;人葡萄球菌对青霉素、氨苄西林的耐药性分别为100.00%、92.31%,对替考拉宁、万古霉素的敏感性均达100.00%。治疗后,观察组患儿的临床疗效优于对照组(Z=30.179,P<0.05)。观察组和对照组患儿Objective To investigate the pathogenic distribution and drug resistance in children with neonatal sepsis caused by coagulase-negative Staphylococci(CNS),and to analyze the efficacy of penicillin combined with vancomycin in the treatment of neonatal sepsis caused by CNS.Methods A total of 185 cases of neonatal sepsis caused by CNS admitted to Nanyang Central Hospital from January 2019 to December 2020 were selected as the research subjects,and the children were divided into the observation group(n=94)and the control group(n=91)according to the treatment method.The children in the control group were treated with penicillin intravenously,50000 U·kg^(-1) at each time,once every 12 hours within 7 days after birth and once every 8 hours after the 7^(th) day of birth;the children in the observation group was treated with vancomycin on the basis of the control group,15 mg·kg^(-1) vancomycin was given intravenously on the first day,the time of intravenous drip was more than 1 hour,once a day;from the second day,10 mg·kg^(-1) vancomycin was given intravenously,the time of intravenous drip was more than 1 hour,once a day.The children in the both groups were treated for 14 days.The strain identification and drug sensitivity was analyzed by using automatic bacterial identification and drug sensitivity analysis system,and the clinical efficacy was evaluated according to the guiding principles for clinical research of antibiotics,the activity of natural killer(NK)cells in whole blood was detected by flow cytometry,the number of white blood cell(WBC)was counted by automatic blood cell analyzer,and the levels of serum immunoglobulin(Ig)G and IgM were detected by automatic biochemical analysis system,and the levels of serum tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-8,C-reactive protein(CRP)were detected by enzyme-linked immunosorbent assay.Results The constituent ratio of the top three of pathogenic bacteria in 185 children with neonatal sepsis caused by CNS were Staphylococcus epidermidis,Staphylococcus haemolytic

关 键 词：凝固酶阴性葡萄球菌 新生儿败血症 病原学 耐药性 广谱青霉素类 万古霉素 

分 类 号：R721[医药卫生—儿科]