住院新生儿感染的细菌耐药性分析

Drug Resistance Analysis of Bacterial Infections in Hospitalized Neonates

目的:探讨住院新生儿细菌感染临床分离株对抗生素的耐药性,以便合理应用抗生素。方法:采集2007年1月～2008年12月70例住院新生儿的痰、血、皮肤分泌物或尿液进行细菌分离培养,鉴定细菌类型并采用琼脂扩散法做药敏试验。结果:89株致病菌中革兰阳性菌以金黄色葡萄球菌及凝固酶阴性葡萄球菌为主;革兰阴性菌以克雷伯菌及大肠杆菌为主。金黄色葡萄球菌及凝固酶阴性葡萄球菌对临床常用的苯唑西林、头孢唑林、头孢噻肟、头孢曲松、头孢呋辛的总体耐药率为27.9%～34.9%。耐苯唑西林球菌正日渐成为新生儿感染的潜在致病菌。头孢哌酮/舒巴坦、苯唑西林、头孢他啶及头孢噻肟对革兰阴性菌耐药率为27.0%～32.4%。苯唑西林、头孢噻肟对新生儿细菌感染较为敏感,亚胺培南对革兰阴性菌有较高敏感性。不论是新生儿社区获得性肺炎还是医院感染性肺炎,病原菌都以金黄色葡萄球菌、大肠杆菌、克雷伯菌最为多见。结论:应根据本地区近年病原菌谱变迁及药敏情况选择合适的抗菌药物。

Objective： To investigate the types and resistance of bacterial infections in hospitalized neonates and instruct early rational clinical drug application. Methods： Acquisitions, in the period of January 2007 - December 2008, of the sputum, blood, skin secretions or urine from 70 patients hospitalized newborns were isolated and cultured. The clinical isolates were identified for microbial identification of bacteria and their antibiotic susceptibility was tested with agar diffusion method. Resulte： Among 89 clinical isolates, staphylococcus aureus and CNS were the main Gram-positive cocci. Klebsiella and Escherichia colt based were the main Gram-negative bacteria. Staphylococcus aureus and CNS＇s average resistance rate to oxaeillin, cefazolin, cefotaxime, ceftriaxone, cefuroxime were 27.9%- 34. 9%. Oxacillin-resistant cocci was becoming potential pathogens of bacterial infection in newborns. The rates of gram-negative bacteria resistance to cefoperazone, oxacillin, ceftazidime and cefotaxime were 27.0%- 32.4%. Oxacillin and cefotaxime to bacterial infection of the newborn were more sensitive, and imipenem in treatment of gram-negative bacteria infection had higher sensitivity. Whether neonatal community-acquired pneumonia or hospital-acquired pneumonia, the most common pathogenic bacterias were Staphylococeas Aureus, Escherichia Colt and Klebsiella. Conclusions ： The types of bacteria and drug resistance dynamics should be examined constantly to guide clinical drug application accordingly and then reasonably.