新生儿血流感染病原菌分布与耐药特征及危险因素分析  

Distribution,drug resistance and risk factors of pathogenic bacteria in neonatal bloodstream infection

作　　者：高爽[1] 孙晓娟[1] 李康怡 GAO Shuang;SUN Xiaojuan;LI Kangyi(Clinical Diagnostic Laboratory,Shenyang Women's and Children's Hospital,Shenyang,Liaoning,110011,China)

机构地区：[1]沈阳市妇婴医院检验科,辽宁沈阳110011

出　　处：《当代医学》2023年第5期10-14,共5页Contemporary Medicine

基　　金：辽宁省自然科学基金项目(20170540839)。

摘　　要：目的分析新生儿血流感染的病原菌分布、耐药特征及危险因素。方法回顾性分析2015年7月至2018年6月本院新生儿病房送检的4015份血培养阳性患儿标本,分离菌株后收集对应菌株血培养阳性患儿的临床资料,分析病原菌分布及耐药特征,并采用Logistic回归分析新生儿血流感染的危险因素。结果4015份送检标本中,共分离病原菌136株,阳性率为3.39%;其中革兰氏阳性菌98株(72.06%),以凝固酶阴性葡萄球菌为主(42.65%);革兰氏阴性菌33株(24.06%),以大肠埃希菌为主(11.76%);白色念珠菌5株,占比3.68%。革兰氏阳性菌对红霉素、克林霉素和克拉霉素的耐药率较高,未检出对万古霉素和利奈唑胺耐药的菌株;革兰氏阴性菌对产超广谱β-内酰胺酶的耐药率较高,未见对碳青霉烯类耐药的菌株。败血症患儿发生血流感染的比例最高,其次为新生儿肺炎,再次为高胆红素血症。Logistic回归分析显示,新生儿高胆红素血症是新生儿发生血流感染的独立危险因素(OR>1,P<0.05)。结论新生儿高胆红素血症是新生儿发生血流感染的独立危险因素,新生儿发生血流感染可引起多种严重临床疾病且病原菌种类多样,临床应针对常见病原菌进行耐药性动态监测,以指导临床用药,改善患儿生存结局。Objective To analyze the pathogenic bacteria,drug resistance characteristics and risk factors of neonatal bloodstream infection.Methods A total of 4015 samples of children with positive blood culture from July 2015 to June 2018 in the neonatal ward of our hospital were ret-rospectively analyzed,the clinical data of the children with positive blood culture of the corresponding strains were collected after isolation,and the distribution and drug resistance characteristics of the pathogens were analyzed,and the risk factors of neonatal bloodstream infection were analyzed by Logistic regression.Results Among 4,015 samples,136 strains of pathogenic bacteria were isolated,with positive rate of 3.39%;among them,98 strains(72.06%)were Gram-positive bacteria,mainly Coagulase-negative staphylococcus(42.65%);33 strains(24.06%)were Gram-negative bacte-ria,mainly Escherichia coli(11.76%);5 strains of Candida albicans,accounting for 3.68%.The resistance rate of Gram-positive bacteria to erythro-mycin,clindamycin and clarithromycin was high,and no strains resistant to vancomycin and linazolamide were detected;the resistance rate of Gram-negative bacteria to the production of ultra-broad spectrumβ-lactamase was high,and no carbapenems resistant strains were detected.The proportion of bloodstream infections was highest in children with sepsis,followed by neonatal pneumonia and hyperbilirubinemia.Logistic regression analysis showed that neonatal hyperbilirubinemia was independent risk factor for neonatal bloodstream infection(OR>1,P<0.05).Conclusion Neonatal hyperbilirubinemia is an independent risk factor for neonatal bloodstream infection,which can cause variety of serious clinical diseases and pathogen-ic bacteria,dynamic monitoring of drug resistance should be carried out for common pathogenic bacteria in clinical practice,so as to guide clinical medication and improve the survival outcome of children.

关 键 词：新生儿 血液感染 病原体 耐药 风险因素 

分 类 号：R446.5[医药卫生—诊断学]