新生儿血培养病原菌分布和耐药性分析

Analysis of distribution and antibiotic resistance of pathogens isolated from blood specimens of neonates

目的：了解我院新生儿血培养常见病原菌的分布及耐药情况,指导临床合理应用抗菌药物。方法：回顾性分析2006年7月～2009年7月我院新生儿败血症患者血液培养的细菌种类分布及抗菌药物耐药情况。结果：4274例新生儿血培养标本共检出细菌185株,总阳性率为4.3%。其中革兰阳性菌171株,占92.4%,以凝固酶阴性葡萄球菌为主（152株）,其次为金黄色葡萄球菌（9株）和肠球菌属（6株）;分离的革兰阴性杆菌仅14株（7.6%,14/185）,主要为大肠埃希菌和肺炎克雷伯菌。葡萄球菌属耐药率最高的抗菌药物为青霉素（93.2%）,其次为红霉素、头孢唑啉、苯唑西林和氨苄西林/舒巴坦,分别为83.8%、82.6%、72.6%、67.7%。革兰阴性杆菌对氨苄西林的耐药率为100%,对头孢唑啉、阿莫西林、替卡西林的耐药率均50%。结论：新生儿血培养的主要病原菌为凝固酶阴性葡萄球菌,且对青霉素、红霉素、苯唑西林、头孢唑啉和氨苄西林/舒巴坦具有较高的耐药性。因此,非常必要对免疫功能尚不完善的新生儿的血培养分离株进行监测和耐药性分析,以为临床医生合理应用抗菌药物提供重要依据。

Objective：To investigate distribution and antibiotic resistance of pathogens causing neonatal septicemia to provide evidence for reasonable use of antibiotics.Methods：The data of isolate distribution and antibiotic resistance of pathogens collected from blood specimens of neonate septicemia patients from July 2006 to July 2009 were analyzed retrospectively.Results：185 pathogenic strains were isolated from 4274 blood specimens,and the positive rate was 4.3%.Of the 185 isolates,171 strains were gram-positive bacteria（92.4%）,and the strains of coagulase negative staphylococci（CNS） were frequently detected（151 isolates）,followed by Staphylococcus aureus（9 isolates） and Enterococcus（6 isolates）;Only 14（7.6%） gram-negative strains were isolated,and escherichia coli and Klebsiella pneumoniae ranked in top two.The resistance rate of staphylococci to penicillin was high（93.2%）,followed by eryhhromycin（83.8%）,cefazolin（82.6%）,oxacillin（72.6%） and ampinicillin/sulbactam（67.7%）.The resistance rate of gram-negative baeteria to ampinicillin was 100%,and the percentage of resistance to cefazolin,amoxicillin,ticarcillin was more than 50%.Conclusion：CNS is the primary pathogens of blood cultures in newborns,and is of higher resistance rate to penicillin,eryhhromycin,oxacillin,cefazolin and ampinicillin/sulbactam.Therefore,to help clinicians prescribe antibacterial drugs reasonably for the treatment of neonate septicemia,it is necessary to monitor the distribution and the resistance of pathogens isolated from blood samples of this kind of patients.