新生儿败血症病原菌与临床药敏试验的分析

The pathogenic bacteria and clinical,susceptibility test analysis of neonatal septicemia.

目的了解目前福州地区新生儿败血症病原菌的分布及药物敏感性现状,结合临床以制定相应对策,合理选择抗生素。方法对1998年1月至2003年12月住院的经血培养证实阳性的125例新生儿败血症的临床资料进行回顾性分析。结果125例败血症共分离出病原菌148株,以葡萄球菌居多(37.8%)。晚期新生儿的败血症发生率高于早发性。早产儿易感肺炎克雷伯杆菌,足月儿易感葡萄球菌。由于青霉素除对B族链球菌敏感率为66.7%,其余均普遍耐药。葡萄球菌对氨苄青霉素、头孢唑林、苯唑青霉素的耐药率在70%左右。敏感药物主要有万古霉素、亚胺培南等。革兰阴性杆菌对氨苄青霉素的总耐药率93.3%,对第三代头孢类及氨基糖苷类药物仍为高敏。近年来ESBLs(+)肺炎克雷伯菌和大肠埃希氏菌产生的比例增加,使临床用药越来越困难,亚胺培南等对此高度敏感。结论凝固酶阴性葡萄球菌感染为本地区新生儿败血症的主要致病菌。产ESBLs肺炎克雷伯菌和大肠埃希氏菌是目前本科的最主要耐药菌株,也是目前院感主要的常见菌。第3代头孢菌素的广泛使用、医护人员的手、器械、院内环境的传播可能是耐药菌株的产生的诱因。临床应予以重视与防范。

Objective： By getting the message of the pathogenic bacteria distribution and current situation of susceptibility test of neonatal septicemia in Fuzhou territory, combining with clinical situation, to formulate corresponding countermeasure and choose the antibiotics reasonably. Methods： The data of 125 neonatal septicemia confirmed by hemoculture from January 1998 to December 2003 in our hospital were analyzed retrospectively. Results： In 148 strain pathogenic bacteria separated from 125 case of neonatal septicemia, the staphylococci was the most （37.8%）. The incidence of septicemia in advanced stage neonatus was higher then the other. To see frequently, the premature suffered by Klebsiella pneumoniae, on the contrary, the infant suffered by staphylococci. The penicillinum was generally drug fast , except the sensitive rate of 66. 7% in B group streptococcus. The staphylococci＇s durg fast rate to Ampicillin （AM）, Cefazolin, Oxacillin was about 70%. It＇s main sensetive drug was Vancomycin, Imipenem. Gram-negative rod＇s genneral drug fast rate to AM was 93.3%, which was still high sensitively to third generation cephalosporim and aminoglycosides. For the past few years, the ESBLs （ ＋ ） Klebsiella pneumoniae and intestine Escherichia infection incidence was increased, which did hard to clinical medication, however, it＇s also high sensitive to Imipenem. Conclusion： Coagulase negative staphylococcus （CN-S） was the major pathogenic bacteria of neonatal septicemia in our hospital. The ESBLs （ ＋ ） Klebslella pneumoniae and intestine Escherichia was the major drug fast bacteria strain in our division. It＇s also the major bacteria of hospital onset of infection （HOI）. The use of the third generation cephalosporim, transmission by hand and apparatus of stuff, the environment of the hospital was the possible motivation of the generation of drug resistant strain, which shoud be think highly and guard against.