79例新生儿败血症细菌分布及耐药性分析

Analysis of bacterial distribution and drug resistance in 79 cases of neonatal sepsis

目的探讨新生儿败血症病原学特点及致病茵耐药情况,为临床治疗提供依据。方法对云南省第一人民医院2008年1月至2011年10月收住的新生儿败血症患儿的血培养及药敏实验结果进行回顾性调查。结果共检出病原菌79株,其中革兰阳性菌70.89%,革兰阴性菌29.11%。排在前五位的细菌分别为表皮葡萄球菌、溶血葡萄球菌、肠球菌属、大肠埃希菌及克雷伯菌属。革兰阳性球菌对青霉素G耐药率达100%,对红霉素及庆大霉素的耐药率高,对万古霉素、替考拉宁、利奈唑胺尚未耐药。革兰阴性杆菌对氨苄西林、派拉西林及头孢呋辛普遍耐药,其中大肠埃希菌及克雷伯菌属对氨曲南、头孢他啶、头孢曲松耐药率高,对阿米卡星、碳青霉烯类尚未耐药,对含β-内酰胺酶抑制剂的复合制剂（如头孢哌酮舒巴坦及派拉西林他唑巴坦）及头孢吡肟耐药率较低;而嗜麦芽窄食单胞菌及鲍曼不动杆菌耐药率高,对头孢类、含β-内酰胺酶抑制剂的复合制剂及碳青霉烯类耐药率达50%~100%。结论根据病原菌及其耐药性检测选用敏感药物治疗新生儿败血症,可减少耐药菌株的产生,提高治疗效果。

Objective To investigate the etiology of sepsis and analyze the drug resistance in neonates.Methods The results of blood culture and drug susceptibility test for neonatal with sepsis in the department of neonatology at hospital from January 2008 to October 2011 were retrospectively analyzed.Results Seventy-nine strains were detected in the blood samples,with Gram-positive bacteria accounting for 70.89% and Gram-negative bacteria accounting for 29.11%.Staphylococcus epidermidis,Staphylococcus haemolyticus,Enterococcus,Escherichia coli and Klebsiella were the five most common pathogens.Gram-positive cocci was strongly resistant to penicillin G（100%）,erythromycin and gentamicin,but still sensitive to vancomycin,teicoplanin and linezolid.The resistance rate of Gram-negative bacilli to ampicillin,piperacillin and cefuroxime was 100%.In Escherichia coli and Klebsiella,the resistance was high to aztreonam,ceftazidime and ceftriaxone,but low to compound containing β-lactamase inhibitors（such as cefoperazone-sulbactam and piperacillin-tazobactam） and cefepime.The sensitivity of Escherichia coli and Klebsiella to carbapenem and amikacin was 100%.Stenotrophomonas maltophilia and Acinetobacter baumannii was 50%-100% resistant to cephalosporins,compound containing β-lactamase inhibitors and carbapenem.Conclusions The selection of sensitive antibiotics based on pathogens and drug resistance testing for the treatment of neonatal sepsis can reduce the generation of drug-resistant strains and increase the therapeutic effects.