危重新生儿感染病原菌分布及预防策略

Distribution and preventive strategies of pathogenic bacteria in critically ill neonates with infection

目的：探讨危重新生儿感染病原菌的分布状况并提出相应的预防策略。方法：对2010年11月-2012年10月平凉市第二人民医院送检的各类危重新生儿细菌培养标本所分离病原菌的分布及药敏结果进行统计分析。结果：共收集病原菌497株，其中痰液样本254株、血液样本109株、尿液样本39株、脓液样本19株、脑脊液样本14株、静脉导管样本7株、创面分泌物样本6株、其他样本3株；497株病原菌中有革兰阴性杆菌342株（68．8％），以肺炎克雷伯菌和大肠埃希菌居多；有革兰阳性球菌131株（26．3％），以表皮葡萄球菌和金黄色葡萄球菌居多；另有真菌24株（4．8％）。肺炎克雷伯菌和大肠埃希菌对头孢唑啉、头孢曲松、氨苄西林／舒巴坦的耐药率很高，均在90％以上，但是对亚胺培南具有100．0％的敏感性；葡萄球菌对氯霉素、红霉素、青霉素的耐药性相对较高，但是对万古霉素的敏感率为100．0％。结论：强化基层医院卫生监管，尽快建立规范化的新生儿重症监护病房（NICU），减少家属陪护，规范医疗和护理行为，可显著减少医务人员手携带多药耐药菌的程度，并有效降低危重新生儿发生医院感染的危险性，促进危重新生儿及时康复。

Objective： To explore the distribution status of pathogenic bacteria in critically ill neonates with infection and put for ward the corresponding preventive strategies. Methods： The distribution of pathogenic bacteria separated from bacterial culture samples and drug allergy results of various neonates from intensive care unit of the hospital from November 2010 to October 2012 were analyzed statistical ly. Results： The experimenters collected 497 pathogenic bacteria totally, among them, 254 strains were from sputum samples, 109 strains were from blood samples, 42 strains were from the end of endotraeheal tube samples, 19 strains were from pus samples, 14 strains were from cerebrospinal samples, 7 strains were from venous duct samples, 6 strains were from the secretion of wound surface, 4 strains were from tho- racic and abdominal cavity fluid samples, 3 strains were from other samples ; there were 342 gram negative bacilli in 497 pathogenic bacteria, accounting for 68.8% , most of them were Klebsiella pneumoniae and Eseheriehia coli; there were 131 gram positive coccus, accounting for 26. 3% , most of them were Staphylococcus epidermidis and Staphylococcus aureus; there were 24 fungus, accounting for 4. 8%. The drug resistance rates of Klebsiella pneumoniae and Escherichia eoli to Cefazolin, Cefiriaxone, Ampicillin/Sulbactam were more than 90% , but they were sensitive to Imipenem, the sensitivity was 100. 0% ; the drug resistance rates of Staphylococcus to Chloramphenicol, Erythromycin, and Penicillin were relatively high, but it was sensitive to Vancomycin, the sensitivity was 100. 0%. Conclusion Strenthenin health su-pervision, establishing normalized NICU, reducing family carers, and standardizing medical and nursing behavior can reduce the degree of multidrug resistant bacteria brought by medical staffg hands, effective-lv reduce the risk of neonatal nosocomial infection in intensive care unit. and promote the timely recovery of critically ill neonates.