新生儿重症监护室多重耐药菌感染分析

Analysis of multiple resistance to antibiotics of infection in neonatal intensive care unit

目的了解我院新生儿重症监护室(NICU)多重耐药菌的菌种和耐药情况。方法对本院NICU2011年4月-2012年3月发生多重耐药菌感染的44例新生儿细菌监测结果进行分析。结果共检出多重耐药菌48株,革兰阴性菌38株,占79.17%,以鲍曼/溶血不动杆菌最多(17株),产超广谱β内酰胺酶(ESBL)阳性14株,占29.17%;鲍曼/溶血不动杆菌对亚胺培南耐药率为76.47%,仅对阿米卡星、妥布霉素敏感,其它革兰阴性菌对氨苄青霉素、氨曲南、除头孢西丁外的头孢类抗生素、哌拉西林耐药率高。革兰阳性菌10株,占20.83%,对阿莫西林/克拉维酸、头孢唑啉、亚胺培南、氨苄青霉素、苯唑青霉素、青霉素耐药率为100%,对利奈唑烷、利福平、万古霉素、奎奴普丁/达福普丁敏感。48株多重耐药菌对3-10类抗生素耐药,平均对6.44+1.66类抗生素耐药。治愈34例,好转3例,死亡2例,自动出院后死亡5例,病死率为15.91%(7/44)。结论本院NICU多重耐药菌感染病原菌以革兰阴性菌为主,对大部分抗生素耐药。

Objective To investigate the strain and multiple resistance to antibiotics of pathogenic bacteria of nosocomial in-fection in Neonatal Intensive Care Unit （NICU）. Methods Bacterial detection were carried out with the total of 44 specimens,col-lected from NICU between April 2011 and March 2012. Results In 44 specimens,a total of 48 strains were isolated,among which 38 were gram-negative bacteria with 79.17%,the majority were acinetobacter baumannii with 17 strains,14 strains were extended-spectrum-β-lactamase （ESBL） with 29.17%. The drug resistance rates of acinetobacter baumannii to imipenem were 76.47%,it was only sensitive to amikacin and nebcin. The drug resistance rates of the other gram-negative bacteria to ampicillin,aztreonam, the cephalosporin antibiotics besides cefoxitin and piperacillin were high. A total of 10 strains were gram-positive bacilli with 20. 83%. All of the drug resistance rates were 100% to amoxicillin clavulanic acid,cefazolin,ampicillin,oxacillin and penicillin,they were sensitive to linezolid,rifampicin,vancomycin and quinupristin/dafoe putin. 48 strains of multiple resistance to antibiotics of pathogenic bacteria were resistant to 3-10 kinds of antibiotics,the average were 6.44＋1.66 kinds. 34 specimens were cured,3 were improved,2 were died,5 were died after leaved hospital automatic,the case fatality rate was 15.91%（7/44）. Conclusion Gram-negative bacilli are the major pathogens that cause neonatal nosocomial infections in NICU of our hospital.