新生儿重症监护室常见病原菌及其耐药性的调查

Investigation of common pathogens and their antimicrobial resistance in NICU

目的了解新生儿重症监护室(NICU)常见感染病原菌的种类及耐药性的变化,以指导临床合理选用抗生素。方法收集福建医科大学附属厦门第一医院NICU 2005年1月至2007年12月细菌培养显示阳性结果的患儿资料共554例,对常见感染病原菌及耐药性的变迁情况进行分析。结果(1)共检出53种595株病原菌,以革兰阴性(G-)菌为主,肺炎克雷伯菌最常见。(2)共检出产超广谱-β-内酰胺酶(ESBL)肺炎克雷伯菌81株,其检出率在3年里有明显下降趋势(P<0.05);而多重耐药的非发酵菌及真菌检出率却逐年上升(P<0.01)。(3)药敏结果显示,G-菌对氨苄西林、氧哌嗪青霉素、头孢唑啉、氨苄西林/青霉烷砜、头孢肤肟耐药率均较高(56.6%～92.2%),显著高于丁胺卡那、氧哌嗪青霉素/他唑巴坦、环丙沙星、亚胺培南、头孢他啶(P<0.05);产ESBL菌对头孢曲松、头孢噻肟完全耐药;革兰阳性(G+)菌对青霉素、头孢唑啉、苯唑青霉素、红霉素耐药率(74.4%～83.4%)显著高于万古霉素和克林霉素(P<0.05)。结论(1)肺炎克雷伯菌仍是本院NICU感染的主要致病菌,但有逐年减少趋势;其产ESBL菌的检出逐年减少,与限制性应用三代头孢关系密切。(2)多重耐药的非发酵菌及念珠菌属逐年增加,渐成为第2、3位常见致病菌,值得警惕。(3)NICU细菌耐药形势严峻,碳青霉素烯类、氧哌嗪青霉素/他唑巴坦以及万古霉素仍可作为NICU中新生儿严重感染的经验用药,但应注意非发酵菌的感染。

Objective To investigate the common bacterial pathogens and the change in their resistance to antibiotics in NICU, and provide guidance for the use of antibiotics. Methods From Jan. 2005 to Dec. 2007 in Xiamen First Hospital Affiliated to Fujian University of Medical Sciences , 554 bacterial culture positive cases were collected. Analyze the common pathogens and the change in their resistance. Results （ 1 ） Fifty-three species out of 595 pathogenic bacteria were detected, Klebsiella pneumonia was of the most common.（2）Eighty-one Klebsiella pneumonia producing extended spectrum β lactamases（ESBL） were detected in total, the detective rate among the three years showing a marked decline （P 〈 0.05 ） , whereas the detective rate of multiple drug resistant non-zymophyte and fungus showed a steady increase over the three years （P 〈 0.01 ）. （3）Drug sensitivity assay revealed that the gram positive cocci possessed a higher degree of drug resistance to ampicillin, piperaeillin, Cefazolin, sulbactam, and Cefuroxime with a percentage of 56.6% 92.2%, which was significantly higher than the resistance to Amikaxin, piperacillin/tazobactam, ciprofloxacin, imipen- em, and cefiazidime （P 〈 0.05 ）. ESBL producing bacteria were totally resistant to cefiriaxone and cefotaxim, and the gram positive bacilli possessed a higher degree of drug resistance to penicillin, cephazoline, oxacillin and erythromycin （ 74.4% - 83.4% ） than to Vancomycin or Clindamycin （P 〈 0.05 ）. Conclusion （ 1 ） Klebsiella pneumonia is a major bacterial pathogen in the NICU of our hospital, fortunately its infection rate shows a decline tendency over recent years, and such a decline in positive rate of ESBLs producing Klebsiella pneumonia is closely relevant to the application of the third generation cephalosporin. （2）Increasing infections due to multiple drug resistant non-zymophyte and mycocandida are gradually becoming 2nd or 3rd common pathogens, which requires certain attention. （3）The drug resistance problem in NICU causes serious concerns. Imipenem, piperacillin/ tazobactam and Vancomycin can be used in NICU as em- pirical drugs for the treatment of severe infection, while non-zymophyte infection should be cared about.