73例败血症早产儿的阴沟肠杆菌培养与药敏试验结果分析

Analysis on Enterobacter cloacae culture and susceptibility testing in 73 sepsis premature children

目的了解导致早产儿医院感染阴沟肠杆菌败血症的危险因素与阴沟肠杆菌的耐药现状,为阴沟肠杆菌败血症的治疗制定合理有效的用药方案,为控制医院感染提供研究数据。方法对73例阴沟肠杆菌败血症早产儿的病例资料进行回顾性调查分析,包括患儿的性别、胎龄、出生体重、临床表现及实验室检查结果等内容。结果早产儿阴沟肠杆菌败血症的临床表现呈现多样化特点,其主要临床表现包括:发热、消化道症状、黄疸、脐部红肿、颅内感染与心肌损害等。实验室检查表明,71.2%患儿中血小板减少,16.4%患儿出现白细胞总计数减少,74.0%患儿出现白细胞总计数升高,64.4%患儿Hs-CRP水平升高。73例患儿共检出阴沟肠杆菌80株,阴沟肠杆菌对亚胺培南、左氧氟沙星、阿米卡星敏感率均达到100%,敏感率较高的抗菌药物还有环丙沙星、头孢吡肟、庆大霉素、妥布霉素和哌拉西林他唑巴坦,而阴沟肠杆菌对大多数β-内酰胺类、磺胺类、氨基糖甙类抗菌药物耐药。结论早产儿阴沟肠杆菌败血症的临床治疗中必须做药敏试验,根据药敏试验结果合理选择抗菌药物。治疗中可首选喹诺酮类药物,尽量避免使用青霉素类、一代、二代头孢菌素,对于重症患儿可首选碳青霉烯类抗菌药物。

【Objective】 To find out the risk factors that lead to premature children hospital infections Enterobacter cloacae sepsis and the status quo of Enterobacter cloacae resistant,to develop reasonable and effective regimen for Enterobacter cloacae sepsis treatment,and to provides research data for controlling hospital infections.【Methods】 The clinical data of 73 cases of Enterobacter cloacae sepsis preterm children were investigated and analyzed,including children＇s gender,gestational age,birth-weight,clinical manifestations,laboratory examination results and other content.【Results】 The clinical manifestations of preterm children with Enterobacter cloacae sepsis diversified characteristics,the main clinical manifestations included fever,gastrointestinal symptoms,jaundice,umbilical redness,intracranial infection with myocardial damage.Laboratory tests showed that 71.2% of children with thrombocytopenia,16.4% of children with reduced total white blood cells,74.0% of children with elevated total leukocyte count,and 64.4% of children with elevated levels of Hs-CRP.80 Enterobacter cloacae were detected in 73 patients.The sensitivity rates of Enterobacter cloacae to imipenem,levofloxacin,amikacin were up to 100%;the other antimicrobial drugs with higher sensitive rates were ciprofloxacin,cefepime,gentamicin,tobramycin,piperacillin tazobactam;Enterobacter cloacae showed resistance to the antimicrobial including most β-lactams,sulfonamides and aminoglycoside.【Conclusion】 The susceptibility testing must be done in the clinical treatment for preterm children with Enterobacter cloacae sepsis,and select reasonable antibiotics based on susceptibility testing results.Quinolones could be the first choice in the treatment,penicillin,first-generation and second-generation cephalosporins should be avoided,and carbapenem antibacterial drugs could be the first choice for severe children.