新生儿败血症血培养菌株近七年的变迁及耐药分析

Study of pathogen aetiology and drugs resistance in neonatal septicemia.

目的探讨新生儿败血症血培养菌株的变迁规律及其耐药情况。方法对2000年1月至2006年12月我院1293例新生儿败血症血培养检出菌、药敏试验结果进行回顾性分析，按阶段分为早期组、中期组和晚期组。用VITEK—AMS鉴定菌株种属，K—B法作抗生素耐药试验，根据NCCLS标准判断结果。结果①早、中、晚期3组分别获血培养菌株615、305和373株，均以G＋菌为主（早、中、晚分别为76．3％、74．1％和65．7％），差异有统计学意义（P〈0．05）。G＋菌中以葡萄球菌占绝对优势；G-杆菌逐渐增多，早、中、晚三个时期分别是21．3％、21．3％和28．4％。②晚期纽中G＋球菌中金黄色葡萄球菌、表皮葡萄球菌对红霉素耐药率高达93．3％和73．7％、复方新诺明耐药率高达87．8％和100．0％，对万古霉素耐药率最低，为2．2％-3．5％、哌拉西林／他唑巴坦、丁胺卡那霉素、环丙沙星耐药率较低。G-杆菌仅对泰能、头孢哌酮／舒巴坦、头孢吡肟敏感，多重耐药菌株多见。结论新生儿败血症血培养多重耐药菌及条件致病菌常见，抗感染治疗应以药物监测结果为依据。

Objective To study pathogen aetiology and distribution of drug resistance in neonatal septicemia. Methods A retrospective study of positive organisms of blood cultures and the results of antimicrobial susceptibility testing was conducted from January 2000 to December 2006 in 1293 cases of neonatal septicemia;The results were divided into three groups：the earlier group, the middle group and the later group. The strains were identified by VITEK-AMS and antibiotics susceptibility was tested by K-B method, results were interpreted according to NCCLS. Results （1）515,305 and 373 strains were identified in the three groups respectively. Gram-positive coccus was dom- inant in three groups（76.3% ,74.1% and 65.7% ） （P 〈0.05）. Among Gram-positive coccus,the most prevalent strains was staphylococcus, Gram-negative bacilli increased gradually, accounting for 21.3 % ,21.3% and 28.4% in three groups respectively;（2）The resistance-rates of Gram-positive coccus staphylococcus aureus and staphylococcus epidermids to erythromycin and sulfamethoxazole/trimethoprim were rather higher： 93.3%, 73.7% vs 87.8% vs 100.0% , respectively, the resistance -rates to penicillin were less, but to susceptible to vancomycin, piperacill/tazobatam,amikacinand ciprofloxacin; gram-negative bacilli were only sensitible to imipenem, cefepime, and cefopera zone/sulbactam;muhiresistances of drug strains was commonly seen. Conclusions It is important for using antibiotics rationally according to drug sensitivity test, because multiresistant strains and opportunistic pathogen are commonly seen.