2020至2022年西安市儿童医院新生儿细菌感染分布及耐药监测分析  

Distribution and drug resistance of pathogenic bacteria in neonates from 2020 to 2022 in Xi’an Children’s Hospital

作　　者：张海金[1,3] 王增国 蔡慧君[2] 赵炳彤[1] Zhang Haijin;Wang Zengguo;Cai Huijun;Zhao Bingtong(Department of Control Infection,Xi’an Children’s Hospital,Xi’an 710003,China;Department of Medical Laboratory,Xi’an Children’s Hospital,Xi’an 710003,China;Xi’an Jiaotong University Health Science Center School of Public Health,Xi’an 710003,China)

机构地区：[1]西安市儿童医院控感办,西安市710003 [2]西安市儿童医院检验科,西安市710003 [3]西安交通大学医学部公共卫生学院,西安市710003

出　　处：《中华实验和临床感染病杂志（电子版）》2023年第4期222-229,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.82172312)。

摘　　要：目的分析2020至2022年于西安市儿童医院住院的新生儿患者细菌感染的病原学分布特点及耐药性。方法收集2020年1月至2022年12月西安市儿童医院住院新生儿分离的病原菌,对其菌株分布及耐药性进行分析,并采用Pearson卡方检验与全国儿童细菌耐药监测数据进行比较。结果由9346例住院患儿临床样本中共分离496株病原菌,其中革兰阴性菌251株(50.60%),革兰阳性菌231株(46.57%);真菌14株(2.83%)。检出菌居前5位病原菌依次为大肠埃希菌(90株、18.15%)、凝固酶阴性葡萄球菌(71株、14.31%)、肺炎克雷伯菌(69株、13.91%)、金黄色葡萄球菌(57株、11.49%)和屎肠球菌(41株、8.27%)。496株病原菌中多重耐药菌184株(37.09%)。多重耐药菌中革兰阴性菌105株(57.07%),革兰阳性菌79株(42.93%)。耐药菌检出率最高的为肺炎克雷伯菌(58株、84.06%),凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、鲍曼不动杆菌和铜绿假单胞菌的耐药菌检出率分别为78.87%(56株)、40.35%(23株)、40.00%(36株)、36.36%(4株)和33.33%(7株)。新生儿所检出病原菌对多种抗菌药物呈现不同程度的耐药性,部分菌株耐药率与全国儿童感染细菌耐药性的监测数据存在较大差异,其中凝固酶阴性葡萄球菌(97.2%)对青霉素类耐药率高于金黄色葡萄球菌(94.7%),本院检出的金黄色葡萄球菌和凝固酶阴性葡萄球菌对克林霉素的耐药率为68.4%和59.2%,显著高于全国监测数据(36.7%和42.3%)(χ^(2)=24.431、P<0.001,χ^(2)=8.119、P=0.004);与全国监测数据相比,本研究所分离大肠埃希菌对头孢类抗菌药物耐药率存在差异,对头孢唑林(75.5%)、头孢呋辛(67.8%)和头孢曲松(65.5%)耐药率均达60%以上,显著高于全国监测数据(58.8%、47.5%和46.6%),差异均有统计学意义(χ^(2)=10.329、P=0.001,χ^(2)=14.674、P<0.001,χ^(2)=12.841、P<0.001)。肺炎克雷伯菌对头孢类抗菌药物耐药率达50%以上,对头孢曲松、头Objective To investigate the characteristics of distribution and drug resistance of bacterial infection in neonates from 2020 to 2022 in Xi’an Children’s Hospital.Methods The specimens were collected from hospitalized neonates from January 2020 to December 2022 in Xi’an Children’s Hospital,and the distribution,composition and drug resistance of the specimens were analyzed,which were compared with the national children surveillance data by Pearson Chi-square test.Results Total of 496 strains of bacteria were isolated from 9346 specimens;including 251(50.60%)strains of Gram-negative bacteria and 231(46.57%)strains of Gram-positive bacteria;14(2.83%)strains of fungi.The top-five bacteria were Escherichia coli(Eco)(90 strains,18.15%),Coagulase negative Staphylococci(CNS)(71 strains,14.31%),Klebsiella peneumoniae(Kpn)(69 strains,13.91%),Staphylococcus aureus(Sau)(57 strains,11.49%)and Enterococcus faecium(Efa)(41 strains,8.27%).Total of 184 strains of multi-drug resistant bacteria were detected from 496 pathogenic bacteria(37.09%);105(57.07%)strains of Gram-negative bacteria and 79(42.93%)strains of Gram-positive bacteria were detected among multiple drug resistant bacteria.The detection rates of Kpn,CNS,Sau,Eco,AB and Pa were 58 strains(84.06%),56 strains(78.87%),23 strains(40.35%),36 strains(40.00%),4 strains(36.36%)and 7 strains(33.33%).The strains were highly resistant to many kinds of antibiotics,some drug resistance rates were significantly different from the national surveillance levels.The resistance rate of CNS(97.2%)to penicillin were significantly higher than those of Sau(94.7%).The resistance rate of Sau and CNS against clindamycin were 68.4%and 59.2%,which were significantly higher than those of the national surveillance levels(36.7%and 42.3%)(χ^(2)=24.431,P<0.001;χ^(2)=8.119,P=0.004).The resistance rates of Eco to cephalosporins were different as the follows:75.5%to cefazolin,67.8%to cefuroxime,65.5%to cefatriaxone,which were significantly higher than those of the national surveillance levels(5

关 键 词：病原菌 耐药性 新生儿 

分 类 号：R446.5[医药卫生—诊断学]