住院新生儿血培养病原菌的变迁、主要病原菌耐药情况及相关危险因素分析  

The changes of pathogenic bacteria,drug resistance of main pathogenic bacteria and related risk factors in blood culture of hospitalized neonates

作　　者：冯燕妮[1] 罗宏成[2] 姚小敏 杨松媚[1] 黄艳[1] 陈娟娟 刘运强[1] 农美杏 梁炎贤 梁玉美[1] FENG Yan-ni;LUO Hong-cheng;YAO Xiao-min;YANG Song-mei;HUANG Yan;CHEN Juan-juan;LIU Yun-qiang;NONG Mei-Xing;LIANG Yan-xian;LIANG Yu-mei(Department of Neonatology,Affiliated Hospital of Youjiang Medical College,Baise,Guangxi 533000,China;Laboratory Department,Affiliated Hospital of Youjiang Medical College,Baise,Guangxi 533000,China)

机构地区：[1]广西右江民族医学院附属医院新生儿科,广西百色533000 [2]右江民族医学院附属医院检验科

出　　处：《中国病原生物学杂志》2022年第7期835-839,843,共6页Journal of Pathogen Biology

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(No.Z2011145);广西自然科学基金青年基金项目(No.2019GXNSFBA245015)。

摘　　要：目的探讨住院新生儿血培养病原菌变迁及主要病原菌耐药情况,并分析新生儿院内感染相关危险因素。方法以2016年1月-2020年12月本院重症监护中心感染的新生儿3284例作为研究对象,收集患儿的年龄、性别、气管插管时间、基础疾病、抗菌药物使用时间、住院时间、药敏、标本及住院时间等临床资料。无菌采集1~3 ml血液于培养瓶中进行病原菌的培养,采用VITEK 2 COMPACT微生物全自动鉴定及药敏分析仪对病原菌进行鉴定和药敏试验,对检出病原菌的分布特点和变迁情况,以及主要病原菌的耐药情况进行分析,采用Logstic回归分析法分析新生儿院内感染的相关危险因素。结果2016年1月-2020年12月新生儿血培养3284份,检出215株病原菌,阳性率为6.17%。表皮葡萄球菌和溶血葡萄球菌的检出率5年间呈下降趋势,表皮葡萄球菌2016年检出率为27.27%,2020年为17.54%,且两种葡萄球菌均为凝固酶阴性葡萄球菌(CNS);溶血葡萄球菌2016年检出率为18.18%,2020年为15.79%。大肠埃希菌和肺炎克雷伯菌检出率5年间呈上升趋势,2016年两种病原菌的检出率分别为9.09%和3.03%,至2020年检出率增长至15.79%和12.28%。药敏检测显示,耐甲氧西林金黄色葡萄球菌(MRSA)耐药率为33.33%,显著低于耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的耐药率70%~90%;溶血葡萄球菌对环丙沙星、左氧氟沙星、苯唑西林及红霉素的耐药率为72.22%~91.67%,高于表皮葡萄球菌的耐药率23.40%~76.60%和溶血葡萄球菌的耐药率12.50%~81.25%。大肠埃希菌对庆大霉素、头孢他啶、庆大霉素、氨苄西林、头孢唑啉、头孢曲松及氨苄西林耐药率为24.14%~75.86%,对哌拉西林、亚胺培南、阿米卡星、妥布霉素及左氧氟沙星耐药率≤10.34%;肺炎克雷伯菌对抗菌药物的耐药率均低于大肠埃希菌,其中对庆大霉素、亚胺培南、头孢曲松、头孢唑林、氨苄西林及头孢他啶耐药率Objective To analyze the changes of pathogenic bacteria in blood culture of hospitalized neonates and drug resistance of main pathogenic bacteria from 2016 to 2020,and to analyze the related risk factors of nosocomial infection in neonates.Methods A total of 3284 newborns infected in the intensive care center of our hospital from January 2016 to December 2020 were prospectively included in the study.Clinical data were collected,including age,sex,endotracheal intubation time,underlying diseases,duration of antibiotics use,drug resistance,length of stay,drug sensitivity,specimens and length of stay,etc.And observe whether there is iatrogenic infection in the children,collect 1~3 ml blood in sterile culture flask,VITEK 2 COMPACT automatic microbial identification and drug sensitivity analyzer was used for identification and drug sensitivity test of extracted pathogenic bacteria.The drug sensitivity results were interpreted according to the CLSI2017 edition standard.The detection rate of pathogenic bacteria and drug sensitivity test results of all blood samples were counted.The distribution characteristics,changes,drug resistance and related risk factors of the detected pathogens were analyzed.Results From January 2016 to December 2020,3284 samples of neonatal blood were cultured,and 215 strains of pathogenic bacteria were detected,with the positive rate of 6.17%.The detection rates of Staphylococcus epidermidis and Staphylococcus haemolyticus showed a downward trend in five years,the detection rate of S.epidermidis in 2016 was 27.27%,and in 2020 was 17.54%,and both staphylococci were coagulase-negative staphylococci(CNS);The detection rate of S.haemolyticus was 18.18%in 2016 and 15.79%in 2020.The detection rates of Escherichia coli and Klebsiella pneumoniae showed an increasing trend over the past five years.In 2016,the detection rates of the two pathogenic bacteria were 9.09%and 3.03%,respectively.By 2020,the detection rates increased to 15.79%and 12.28%,respectively.The drug sensitivity test showed that the drug r

关 键 词：新生儿 血培养 病原菌 变迁情况 耐药性 相关性分析 

分 类 号：R378[医药卫生—病原生物学]