我院新生儿败血症患者病原菌分布及抗菌药物应用分析

Pathogen Distribution and Application of Antibacterial Drugs in Neonatal Septicemia of Our Hospital

目的：了解新生儿败血症患者的病原菌分布特点、细菌耐药情况及抗菌药物使用情况,为临床合理用药提供依据。方法：回顾性调查沧州市中心医院2012年9月-2013年9月新生儿科收治确诊败血症的病例,将所筛选病例的病原学检出结果、细菌耐药情况及抗菌药物的使用情况进行分析总结。结果：所调查的198例病例共检出病原菌212株,其中主要有47.2%的革兰阳性（G＋）菌、29.7%的真菌及23.1%的革兰阴性（G-）菌。以表皮葡萄球菌为主G＋菌及以肺炎克雷伯菌为主的G-菌,对头孢西丁的耐药率分别为85.2%、18.2%,两种菌对碳青霉烯类的耐药情况分别为66.7%及0;以念珠菌为主的真菌对伊曲康唑的敏感率较低。在抗菌药物使用中,仅我院的特殊使用级抗菌药物品种（头孢吡肟、两性霉素B、万古霉素、亚胺培南/西司他丁、美罗培南）按药敏选药比例较高,达48.5%~100%,其余多数为经验用药。结论：我院新生儿败血症患者的病原菌的耐药率较高,且为多重耐药,情况较为严重,这与临床经验用药密不可分,需高度引起重视以提高合理用药水平。

OBJECTIVE： To investigate the pathogen distribution, drug resistance and the application of antibacterial drugs in neonatal septicemia, and to provide the basis for rational drug use. METHODS： A retrospective evaluation was performed for neo- natal septicemia from Sept. 2012 to Sept. 2013 in Cangzhou Central Hospital. Results of etiological examination, drug resistance of bacterials and application of antibacterial drugs were summarized and analyzed. RESULTS： Totally 212 strains of pathogens were detected in 198 cases, of which there were 47.2% G＋ bacteria, 29.7% fungus and 23.1% of G- bacteria. The resistance rates to cefoxitin of the G~ bacteria as Staphylococcus epidermis and G- bacteria as Klebsiella pneumonia were 85.2% and 18.2%, respec- tively. The resistance rates to carbapenems of two strains were 66.7% and 0, respectively. Fungus as Candida fiangus had low sensi- tivity to itraconazole. Large proportion of antibacterial drugs was selected for special purposes （cefepime, amphotericin B, vanco- mycin, imipenern/cilastatin, meropenem） in our hospital according to drug sensitivity, being up 48.5% to 100%. Empirical medica- tion was found in major cases. CONCLUSIONS： The pathogens have high resistance in neonatal sepsis patients in our hospital rates and the most of the pathogens are the multi-drug resistance. The situation is more serious, which is closely related to the clinical ex- perience of drug use. Great importance should be paid to it so as to improve rational drug use.