2003—2005年新生儿感染常见致病菌及耐药性的变迁

Changes of common pathogenic bacteria and their antimicrobial resistance in newborns with infections from 2003 to 2005

目的了解本地区新生儿2003至2005年感染常见致病菌的种类及耐药的现状,以指导临床合理应用抗生素。方法收集我院新生儿科2003年1月至2005年12月收治的613份体液培养阳性(痰液、血液、分泌物、胃液等标本)的患儿资料,对常见检出菌及其耐药性的变迁情况进行分析。结果共检出40种613株病原菌,以革兰阴性杆菌为主约占57·6%,而肺炎克雷伯菌和大肠埃希菌分别位于前二位,其产ESBLs菌株检出率分别为78·1%和82·6%。药敏结果显示,常见致病菌对青霉素、第一、二代头胞类抗生素、红霉素类耐药性显著增加,但对第三代头胞类抗生素如头孢曲松、头孢噻肟(凯福隆)、头孢他啶(复达欣)及β内酰胺酶抑制剂复方制剂、碳青霉烯类、万古霉素等较敏感。产ESBLs菌仅对亚胺培南及β内酰胺酶抑制剂复方制剂敏感。结论革兰阴性杆菌特别是肺炎克雷伯菌和大肠埃希菌是新生儿感染主要病原菌,产ESBLs菌比例增加应引起高度重视。碳青霉烯类、哌拉西林/三唑巴坦和头孢哌酮/舒巴坦,可作为新生儿严重医院感染经验用药,应尽量根据药敏试验调整抗生素。

Objective To investigate the eipdemiologieal characteristics of bacterial agents and their in vitro antimierobial susceptibility in our hospital. Methods Distribution and resistance of pathogens were analyzed in 613 culture-positive samples getting from 613 newborn infents in recent 3 years. Results In all 613 pathogens, 353 strains were Gram-negative bacilli （57. 6% ）. Klebsiella pneumonia and E Coli were the most common Gram-negitive bacillis, 78. 1% and 82. 6% of them were extend-spectrum β- lactamase（ESBL）-producing strains. The resistance rates of pathogenic bacteria to penicillin , the first and second eephalosporins were significantly higher; but the resistances to some of the third eephalosporins, that of antibiotics supplemented with β- laetamase-inhibitors and earbopenems were significantly lower. Conclusions Gram-negative bacilli are the major pathogens causing neonatal infection in NICU. The tendency of infections caused by ESBL-produing Klebsiella pneumonia and E Coli increases. Imipenem, piperaeillin/tazobaetam and eefoperazone/sulbaetam can be chosen as empirical antibiotics for severe neonatal nosoeomial infection.