新生儿败血症病原菌变迁及耐药分析

PATHOGENIC BACTERIA OF NEONATAL SEPTICEMIA: THE CHANGES IN TEN YEARS AND DRUG-RESISTANCE ANALYSES

①目的了解我院近十几年新生儿血培养检出菌及其耐药性的变迁,以指导临床用药.②方法对1990年1月～1992年12月(第1组)收治的新生儿败血症血培养检出菌和药敏试验结果进行回顾性调查,并与2000年1月～2002年12月(第2组)的调查结果进行分析比较,第1组采用葡萄糖肉汤培养,API系统及手工鉴定,第2组用BD血培养仪培养,ATB细菌自动鉴定仪鉴定.③结果凝固酶阴性葡萄球菌(CNS)检出构成比由原来的25.5%上升至68.5%,肠球菌和微球菌的检出构成分别由2.0%、1.0%上升到3.4%、5.6%;而金黄色葡萄球菌(简称金葡菌)及大肠埃希菌则由30.4%、20.6%下降至6.7%、5.6%;金葡菌和CNS对苯唑青霉素、红霉素和庆大霉素的耐药率均明显升高(χ2＝3.86～7.14,P<0.05),耐甲氧西林金葡菌(MRSA)占83.3%,耐甲氧西林CNS占87.1%.大肠埃希菌对亚胺培南-西司他丁、妥布霉素尚无耐药性.④结论低毒力条件致病菌特别是CNS成为当前我院新生儿最常见的致病菌,且其耐药性在增加;而金葡菌和大肠埃希菌的感染明显减少.

Objective To investigate the changes of bacteria and their drug resistance in neonatal septicemia in the last 10 years, and to instruct clinical medication. Methods The results of bacteria detected from blood culture of the patients and drug sensitivity, from January 1990 to December 1992 （group Ⅰ ）, were compared with those from January 2000 to December 2000 （group Ⅱ ）. Glucose broth and API system were applied for culture and differentiation in group Ⅰ. BD blood culture apparatus was used for culture, ATB for differentiation in group Ⅱ. Results Coagulase negative Staphylococci （CNS） increased from 25.5 % in group Ⅰ to 68.5% in group Ⅱ. Enterococcus and micrococcus, increased from 2.0% and 1.0% in early 1990＇s to 3.4% and 5.6% in early 2000＇s, respectively. Staphylococcus aureus and Escherichia coli decreased from 30.4% and 20.6% to 6.7% and 5.6%, respectively. The drug resistance to methicillin, erythromycin and gentamicin was significantly increased in staphylococcus aureus and CNS （X^2= 3.86-7.14,P〈0.05）. Methicillin resistant staphylococcus aureus （MRAS） and methicillin resistant CNS accoun ted for 83. 3% and 87. 1%, respectively. No resistance to tienam and tobramycin was found in Escherichia coli. Conclusion Low-virulence conditional pathogenic bacteria , CNS in particular, become commonly seen in newborns in our hospital, and their resistance have been increasing, while the infection with staphylococcus aureus and Escherichia coli decreasing.