新生儿败血症308例病原菌变迁及耐药性分析  

Analysis of pathogenic bacteria variability and drugresistance in 308 neonatal sepsis cases

作　　者：赵伟[1] 蒋翠莲 冯晓丹[1] ZHAO Wei;JIANG Cuilian;FENG Xiaodan(Department of Laboratory,Women's Hospital of Nanjing Medical University,Nanjing Women and Children's Health Care Hospital,Nanjing,Jiangsu 210000,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)检验科,江苏南京210000

出　　处：《安徽医药》2024年第8期1624-1628,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨新生儿败血症病原菌变迁及耐药情况。方法收集2017年1月至2022年12月南京医科大学附属妇产医院(南京市妇幼保健院)确诊的308例新生儿败血症的临床资料,回顾性分析病原菌分布特征及耐药情况。结果共检出332株非重复菌株,排名前4位的菌株为凝固酶阴性葡萄球菌(GNS)、大肠埃希菌、无乳链球菌、肺炎克雷伯菌。6年间革兰阳性菌检出率均高于革兰阴性菌,GNS、大肠埃希菌检出率总体呈上升趋势。除无乳链球菌在足月儿以及正常体质量儿组检出株数最多外,其他主要病原菌均在超早及极早产儿、超低及极低体质量儿组检出比率较高。大肠埃希菌、肺炎克雷伯菌对氨苄青霉素、第一代头孢菌素的耐药率均较高,对碳青霉烯类抗生素完全敏感。表皮葡萄球菌对大部分抗菌药物的耐药性高于金黄色葡萄球菌。无乳链球菌对克林霉素、红霉素、四环素的耐药率较高;未发现对万古霉素、利奈唑胺耐药菌株。结论新生儿败血症检出病原菌以GNS、大肠埃希菌为主,且各病原菌在不同类别病儿中的分布差异有统计学意义,应定期对病原菌分布及耐药性进行监测,以进一步规范指导临床抗生素的合理使用。Objective To explore the changes of pathogenic bacteria and drug resistance in neonatal sepsis.Methods Clinical data of 308 cases of neonatal sepsis diagnosed in Women's Hospital of Nanjing Medical University,Nanjing Women and Children's Health Care Hospital between January 2017 and December 2022 were collected,and the distribution characteristics and drug resistance of pathogenic bacteria were retrospectively analyzed.Results A total of 332 non-repeat strains were detected,and the top 4 strains were coagulase-negative staphylococci(GNS),Escherichia coli,streptococcus agalactiae and Klebsiella pneumoniae.The detection rate of Gram-positive bacteria was higher than that of Gram-negative bacteria,and the detection rates of GNS and Escherichia coli were generally on the rise during the 6-year period.Except for streptococcus agalactiae,which was detected frequently in term and normal weight infants,all other major pathogens with higher rates were detected in ultra-premature and very premature infants,and ultra-low and very low weight infants.Escherichia coli and Klebsiella pneumoniae had high resistance rates to ampicillin and first-generation cephalosporins,and were fully susceptible to carbapenem antibiotics.Staphylococcus epidermidis was more resistant to most antibacterial drugs than Staphylococcus aureus.Streptococcus agalactiae and Enterococcus faecalis had higher resistance rates to clindamycin,erythromycin and tetracycline;no resistant strains to vancomycin and linezolid were found.Conclusion The pathogenic bacteria detected in neonatal sepsis were mainly GNS and Escherichia coli,and the distribution of each pathogenic bacteria existed differently in different categories of children,and the distribution and drug resistance of pathogenic bacteria should be monitored regularly to standardize and guide the rational use of clinical antibiotics.

关 键 词：新生儿败血症 病原菌变迁 耐药性 合理用药 

分 类 号：R446.5[医药卫生—诊断学] R722.131[医药卫生—临床医学]