新生儿重症监护室中院内获得性血流感染的病原学及药敏分析

Analysis on etiology and antibiotic susceptibility of nosocomial bloodstream infection in NICU

目的:探讨新生儿重症监护室(NICU)中院内获得性血流感染(BSI)的病原学分布及耐药情况,为临床合理使用抗生素提供依据。方法:回顾性分析2005年1月～2006年12月期间入住圣路易斯华盛顿大学圣路易斯儿童医院NICU的所有新生儿的住院资料。结果:新生儿院内获得性血流感染的病原菌以G+球菌占多数,其中以血浆凝固酶阴性的葡萄球菌(CNS)为主,其次为肠球菌和金黄色葡萄球菌。G-杆菌中以克雷伯氏菌最常见,大肠埃希菌次之。导管相关性血流感染组(CRBSI组)中的真菌感染比例明显高于非导管相关性血流感染组(non-CRBSI组)(P=0.027)。除1例耐万古霉素的肠球菌(VRE)外,常见G+球菌均对万古霉素100%敏感,其次为利福平。对青霉素和苯唑青霉素的耐药性均较高。G-杆菌中大多数细菌对氨苄青霉素完全耐药,大肠埃希菌和粘质沙雷氏菌均对庆大霉素和头孢三代高度敏感,而克雷伯氏菌对头孢他啶和头孢噻肟的耐药率高达50%。结论:NICU中院内获得性BSI的病原菌以CNS最常见。青霉素和氨苄青霉素总体耐药现象严重,已不适合作为一线用药,故有必要在使用抗生素前及时完善病原学检测和药物敏感试验,以指导临床合理用药。

Objective：To study the constituent ratio and antimicrobial susceptibility patterns of pathogenic bacteria in patients with nosocomial bloodstream infection（BSI） in NICU.Methods：Data were collected retrospectively among neonates who admitted to NICU in St Louis Children＇s Hospital of Washington University from January 2005 to December 2006.Results：Coagulase-negative staphylococci（CNS） were the most common agents in gram-positive organisms and Klebiella in gram-negative bacteria.Significantly more fungi BSI were catheter-related（10.9%） compared with non-catheter related（2.9%,P=0.027）.The best susceptible antibiotics for gram-positive was Vancomycin,followed by Rifampin.Gentamycin and Third-generation cephalosporin showed high sensitivity t Escherichia coli and Serratia marcescens.But Klebiella showed high resistant to ceftazidime and cefotaxime.Almost all gram-negative bacteria showed resistant to ampicillin and most of gram-positive bacteria resistant to penicillin and oxacillin.Conclusion：CNS is the most common pathogenic organism of nosocomial BSI in NICU in this study.The drug resistance of microbial is severe,especially to penicillin and ampicillin which are no longer the first choice clinically.So blood culture should be examined when initiating antibiotics treatment for BSI.