新生儿血流感染病原菌分布及耐药性新趋势研究

Study on bacterial distribution of newborn bloodstream infection and the new trend of drug resistance

目的探讨新生儿血流感染病原菌的分布情况以及耐药性的新趋势。方法选取深圳市妇幼保健院(以下简称"我院")2009年及2012年收治的新生儿,运用BACTEC9240全自动血培养仪进行血培养,并运用DL-医学检验系统进行菌株鉴定,最后对其血流感染病原菌的分布及耐药性情况进行统计分析。结果 2012年我院新生儿血流感染病原菌的分离阳性率明显高于2009年(26.3%比11.2%),差异有统计学意义(P<0.05)。革兰阴性需氧杆菌是我院新生儿血流感染的主要病原菌。与其他抗菌药物相比,抗革兰阴性菌药物亚胺培南的耐药率明显较低(P<0.05);枸橼酸杆菌、肠杆菌和沙雷菌对第三代头孢菌素耐药率显著上升;革兰阳性菌耐药菌株比例有上升的趋势。结论革兰阴性需氧杆菌是我院近年来新生儿血流感染的主要病原菌,临床在使用抗菌药物时应予以重视,并且枸橼酸杆菌、肠杆菌和沙雷菌等抗菌药近年来耐药性有显著提升,医院需要对其进行有效控制,合理应用抗菌药物,并加强管理。

Objective To discuss the bacterial distribution of newborn bloodstream infection and the new trend of drug resistance. Methods Newborn babies treated in Maternity and Child Care Centers of Shenzhen City （＂our hospital＂ for short） in 2009 and 2012 were selected. Automatic blood culture instrument BACTEC9240 was adopted for blood cul- ture, and DL-lab information system was used for strain identification. Finally, distribution and drug resistance of pathogenic bacteria in bloodstream infections were statistically analyzed. Results Bacterial isolation rate of newborn bloodstream infection in 2012 was obviously higher than that of 2009 （26.3% vs 11.2%）, the difference was statistically significant （P 〈 0.05）. The study found that gram-negative aerobic bacteria was the main pathogen bacteria of neonatal bloodstream infection in our hospital. Compared with other antibacterial drugs, Imipenem drug resistance against gram- negative bacteria was significantly lower （P 〈 0.05）. In addition, drug resistant rates of citrobacter, enterobacterium and serratia against the third generation of cephalosporin increased significantly in the past three years, and the proportion of drug resistant strains was rising in gram-positive bacteria. Conclusion Gram-negative aerobic bacteria is the main pathogen causing newborn bloodstream infection in our hospital in recent years. Antimicrobial agents against this bac- terium should be paid special attention in application. And drug resistance of antimicrobial agents against citrobacter, enterobacterium and serrata has also been obvious improved. So the hospital needs to effectively control bacterial drug resistance, and rationally use antibacterial drugs, strengthen its management.