新生儿败血症病原菌分析与抗生素的选择

Pathogens of Neonatal Septicemia and Antibiotics Selection

目的 :探索预防和治疗新生儿败血症的有效方法 ,以减少发病率和病死率。方法 :对我院近 10年来收住的 10 7例血培养阳性 ,确诊为新生儿败血症的病原菌、围生期易感因素和抗菌药物进行分析 ,并与本院 70～ 80年代资料进行对比。结果 :病原菌以葡萄球菌为主 ,共 44例 ( 41 12 % ) ,其中金黄色葡萄球菌 2 6例 ( 2 4 30 % ) ,四联球菌 2 3例 ( 2 1 5 0 % ) ,鼠伤寒沙门氏菌 16例 ( 14 95 % ) ,大肠埃希氏菌 9例 ( 8 41% ) ,机会菌共 5 4例 ( 5 0 46 % )。与本院 70～ 80年代资料相比 ,病原菌流行情况改变 ,耐药菌株增加 ,医院内获得性感染增多 ,使原本有效抗生素达不到预期效果。结论 :医护人员应加强卫生宣教 ,预防围产易感因素的发生 ,做好日常护理工作 ,严格执行消毒隔离制度和无菌操作 ,防止院内感染和交叉感染的发生。对拟诊新生儿败血症病例 ,立即做血培养及药敏 ,先根据可能病原选用疗效接近的抗生素 ,然后通过细菌药敏调整抗生素种类 。

Objective:To search for effective ways of preventing and treating neonatal septicemia so as to decrease the morbidity and mortality.Method:Pathogens,susceptible factors during perinatal period and antibiotics were studied in 107 cases diagnosed as neonatal septicemia with positive blood culture,admitted in the past ten years,the data were compared with that of 1970s.Results:Staphylococcus was the main pathogen in 44 cases,accounting for 41.12%,among which 26(24.30%) were staphylococcus aureus.In 23 cases(21.50%),tetracocus came second.The others were salmonella Typhimurium(16 casese,14.95%),escherichia coli(9 cases,8.41%)and opportunist(54 cases,50.46%). Compared with the data of 1970s,the epidemicity of pathogens changed,drug resistant strains and hospital-acquired infection increased so that antibiotics could not be as effective as before.Conclusions:Medical workers should guard against the susceptible factors during perinatal period,carry out disinfection and isolation system strictly so as to prevent the occurrence of hospital-acquired infection and cross infection.Blood should cultured and sensitive medicine be tested as quickly as possible to those patients suspected to be neonatal septicemia and antibiotics be used according to possible pathogen firstly,then changed to sensitive medicine as the medicine test indicated.