新生儿败血症临床特点和病原菌构成及耐药状况分析

Clinical analysis of pathogenic bacteria composition and drug resistance in neonatal septicemia

目的 分析新生儿败血症临床特点和病原菌构成及耐药状况,以指导临床合理用药.方法 回顾性分析四川省绵竹市人民医院2007年1月至2012年12月106例确诊为新生儿败血症患儿的主要临床特点、致病菌及药敏试验结果.结果 新生儿败血症临床表现多不典型,多表现为反应差、体温异常、黄疸退而复现或加重、少吃、呼吸窘迫.病原菌构成以革兰阳性菌为主,占63.2%（67/106）,排名前5位的致病菌分别为表皮葡萄球菌（24.5%）、大肠埃希菌（16.0%）、溶血性葡萄球菌（13.2%）、金黄色葡萄球菌（7.5%）、肺炎克雷伯菌（7.5%）.耐药菌占30.2%（32/106）.病原菌对青霉素、氨苄西林、红霉素的耐药性均达100.0%;对万古霉素、亚胺培南、哌拉西林/他唑巴坦、左氧氟沙星、阿米卡星的耐药率低,为0~37.5%.结论 新生儿败血症临床表现多样,缺乏特异性.葡萄球菌及大肠埃希菌为主要致病菌,耐药情况严峻.应重视病原菌耐药性检测,根据血培养结果选用敏感抗生素,以减少耐药菌的产生.

Objective To analyze pathogens in neonatal septicemia and the antimicrobial resistance of these bacteria. Methods The data of 106 neonatal patients with septicemia from January 2007 to December 2012 was retrospectively analyzed. Results The clinical manifestations were not typical, including abnormal body temperature,poor response,Jaundice recurrence or aggravate,eat less and respiratory distress. Gram-positive bacteria was the main pathogen in neonatal septicemia. Staphylococcus epidermis, escherichia coli, hemolysis staphylococcus, staphylococcus aureus and klebsiella pneumoniae were the five most common pathogens.The drug resistant bacteria accounted for 30.2%. The pathogens demonstrated a strong resistant to penicillin,ampicillin and erythromycin; the susceptibility to vancomycin, imipenem, piperacillin/tazobactam,levofloxacin and amikacin was significant. Conclusions The clinical manifestations of neonatal septicemia are multiple and not specific. Among the isolated pathogenic bacteria, the most common ones are staphylococcus and escherichia coli. Choosing sensitive antibiotics based on the drug sensitivity tests may decrease the occurrence of drug-resistant bacteria.