血培养阳性时间对新生儿脓毒血症诊断价值及病原菌药敏分析

Value of time of positive blood culture in diagnosis of sepsis in neonates and drug susceptibilities of pathogens

目的调查血培养阳性时间对明确诊断新生儿脓毒血症及确定病原菌,指导临床合理应用抗菌药物。方法回顾性分析2009年2月1日-2014年2月1日新生儿科血培养结果;药敏数据用WHONET 5.6软件进行分析。结果共分离出187株病原菌,其中细菌141株、假丝酵母菌属16株、污染菌30株,主要革兰阴性菌依次为大肠埃希菌22株、肺炎克雷伯菌17株、阴沟肠杆菌4株和阪崎肠杆菌3株;主要革兰阳性球菌依次为金黄色葡萄球菌27株、溶血葡萄球菌22株、腐生葡萄球菌10株和肺炎链球菌7株,其中甲氧西林敏感金黄色葡萄球菌占88.89%,大肠埃希菌和肺炎克雷伯菌产ESBLs检出率分别为9.10%、5.88%;革兰阴性菌对三代头孢菌素、美罗培南和亚胺培南等较敏感,革兰阳性菌对万古霉素、肺炎链球菌对青霉素和三代头孢菌素较敏感,未发现耐万古霉素葡萄球菌。结论血培养36h阳性结果对新生儿脓毒血症病原菌阳性检出率较高,指导临床合理应用抗菌药物具有重要价值,临床医师应高度重视血培养,根据药敏结果合理使用抗菌药物,减少多药耐药菌株的出现,预防控制医院感染。

OBJECTIVE To study the value of positive time of blood culture in diagnosis of sepsis in the neonates and define the distribution of pathogens so as to provide guidance for reasonable clinical use of antibiotics . METHODS The results of the blood culture for the neonates who were treated in the pediatrics department from Feb 1 ,2009 to Feb 1 ,2014 were retrospectively analyzed ,and the data of the drug susceptibility testing were ana‐lyzed by using WHONET 5 .6 software .RESULTS A total of 187 strains of pathogens have been isolated ,including 141 strains of bacteria ,16 strains of Candida spp ,and 30 strains of contaminated bacteria .Among the major spe‐cies of gram‐negative bacteria isolated ,there were 22 strains of Escherichia coli ,17 strains of K lebsiella pneu‐moniae ,4 strains of Enterobacter cloacae ,and 3 strains of Enterobacter sakaz akii ;among the major species of gram‐positive cocci isolated ,there were 27 strains of Staphylococcus aureus ,22 strains of Staphylococcus haemo‐lyticus ,10 strains of Staphylococcus saprophyticus ,and 7 strains of Streptococcus pneumoniae ,and the methicil‐lin‐sensitive S .aureus accounted for 88 .89% ;the isolation rates of the ESBLs‐producing E .coli and K .pneumoni‐ae were 9 .10% and 5 .88% ,respectively .The gram‐negative bacteria were highly susceptible to the third genera‐tion cephalosporins ,meropenem ,and imipenem ;the gram‐positive cocci were highly susceptible to vancomycin , the S .pneumoniae was highly susceptible to penicillin and the third generation cephalosporins ,and no vancomycin‐resistant Staphylococcus was detected .CONCLUSION The positive 36‐hour blood culture result may contribute to the high detection rate of the pathogens causing sepsis in the neonates and has significant value in guidance of reasonable use of antibiotics .It is necessary for the clinicians to pay great attention to the blood culture and rea‐sonably use antibiotics based on the results of drug susceptibility testing so as to reduce the multidrug‐resistant strains and control the nosocomial infections .