111例新生儿早发型败血症脐血培养阳性结果分析  

Analysis of positive umbilical cord blood culture results in 111 neonates with early onset sepsis

作　　者：董彤 陶蓉 包盈颖 Dong Tong;Tao Rong;Bao Yingying(Department of Neonatology,Women's Hospital School of Medicine,Zhejiang University,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属妇产科医院新生儿科,杭州310000

出　　处：《国际儿科学杂志》2024年第9期634-638,共5页International Journal of Pediatrics

摘　　要：目的分析脐血培养阳性的新生儿早发型败血症(early onset sepsis,EOS)患儿的脐血中病原菌构成、主要病原菌耐药情况及脐血培养阳性时间。方法回顾性分析浙江大学医学院附属妇产科医院新生儿科2021年1月1日至2022年12月31日收治的111例新生儿脐血培养阳性并诊断为EOS的病原菌种类及构成比例,比较脐血中主要革兰阳性菌、革兰阴性菌和真菌的耐药情况及脐血培养阳性时间。结果111例新生儿的脐血培养共分离出病原菌114株,其中3例培养结果包含2种病原菌。114株病原菌中革兰阳性菌69株,占比60.5%,以粪肠球菌和B族链球菌(Group B streptococcus,GBS)为主;革兰阴性菌43株,占比37.7%,以大肠埃希菌为主;真菌2株,占比1.8%,均为白色念珠菌。脐血培养阳性时间在不同病原体中有所区别,革兰阳性菌明显长于革兰阴性菌[(36.3(21.6,48.2)h比20.4(16.5,33.8)h,Z=3.539,P<0.01]。药敏试验结果提示:革兰阳性菌中粪肠球菌对四环素及红霉素耐药率较高,分别为52.9%和47.1%;GBS对克林霉素和红霉素耐药率较高,分别为87.5%和75.0%;粪肠球菌和GBS均对青霉素、利奈唑胺和万古霉素敏感;革兰阴性菌中大肠埃希菌对亚胺培南、厄他培南、头孢西丁、头孢哌酮舒巴坦、阿米卡星和替加环素均敏感,对复方新诺明耐药率较高(61.3%)。结论EOS新生儿的脐血培养阳性病原菌主要为粪肠球菌、GBS和大肠埃希菌,革兰阴性菌的脐血培养阳性时间明显短于革兰阳性菌,而脐血培养中的细菌对常用抗生素耐药率较低。Objective To investigate and evaluate the pathogenic bacterial composition,drug susceptibility of pathogens,and the time to positive in umbilical cord blood culture(UCBC)of newborns with early onset sepsis(EOS).Methods The clinical data of 111 newborns with EOS with positive UCBC admitted to the neonatology department in Women's Hospital School Medicine of Zhejiang University from 1st January 2021 to 31st December 2022 were retrospectively analyzed.The patients were divided into Gram-positive bacteria group,Gram-negative bacteria group and fungal group.The pathogenic bacteria composition,drug susceptibility of pathogens and time to positive in UCBC of the three groups were compared.Results A total of 114 strains of bacteria were isolated from 111 neonates and 2 types of pathogenic bacteria were cultured from 3 newborns of UCBC.Among the 114 pathogenic bacteria,69 strains were Gram-positive,accounting for 60.5%,and the Gram-positive bacteria were mainly Enterococcus faecalis and Group B streptococcus(GBS).There were also 43 Gram-negative strains accounting for 37.7%,primarily Escherichia coli.Two strains of fungi,both of which were Candida albicans,accounted for 1.8%.Additionally,the time to positive in UCBC varied among different pathogens.Gram-positive bacteria had a significantly longer detection time than Gram-negative bacteria[(36.3(21.6,48.2)hours vs.20.4(16.5,33.8)hours),Z=3.539,P<0.01].The rate of drug resistance was found to be high in Enterococcus faecalis against tetracycline(52.9%)and erythromycin(47.1%).GBS showed resistance against clindamycin(87.5%)and erythromycin(75.0%).Both Enterococcus faecalis and GBS exhibited sensitivity towards penicillin,linezolid,and vancomycin.Among Gram-negative bacteria,Escherichia coli was sensitive to imipenem,ertapenem,cefoxitin,cefoperazone-sulbactam,amikacin and tigecycline,and had a high resistance rate to cotrimoxazole(61.3%).Conclusion Enterococcus faecalis,GBS,and Escherichia coli were predominant microorganisms identified in UCBC of newborns with EOS.The posit

关 键 词：婴儿 新生 早发型败血症 脐血培养 病原菌 耐药性 

分 类 号：R722.131[医药卫生—儿科]