新生儿败血症病原菌分布及耐药性分析

Distribution of pathogenic bacteria and analysis of drug sensitivity in 121 infants with neonatal septicemia

目的研究医院新生儿败血症病原菌的分布及耐药性,指导临床合理使用抗菌药物。方法采用病例对照研究的方法,对医院2006年1月-2011年5月新生儿重症监护病房121例败血症确诊患儿进行回顾性分析,按发病时间分为早发型及晚发型败血症,并根据发生感染的地点分为社区获得性感染及医院感染。结果新生儿败血症病原菌以革兰阴性菌为主,73株占60.33%,革兰阳性菌44株占36.36%,真菌4株占3.31%,早发型与晚发型败血症中大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、阴沟肠杆菌、金黄色葡萄球菌、白色假丝酵母菌、链球菌属与败血症比较,差异有统计学意义(P<0.05),社区与医院感染败血症中大肠埃希菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌、金黄色葡萄球菌、白色假丝酵母菌比较,差异有统计学意义(P<0.05),产ESBLs大肠埃希菌、肺炎克雷伯菌检出率分别为15.79%、16.67%;革兰阴性菌、革兰阳性菌对青霉素、氨苄西林均耐药。结论早发型及晚发性败血症、社区获得性及医院感染败血症病原谱不同,均有多药耐药菌产生。

OBJECTIVE To study the distribution of pathogens and their drug resistances in neonatal septicemia in our hospital, so as to provide clinical guidance of antibiotic usage. METHODS A retrospective analysis was conducted on 121 infants with neonatal septicemia who were admitted to the neonatal department of our hospital from Jan. 2006 to May 2011. The infants were divided into the group of early-onset neonatal sepsis and the group of late-onset neonatal sepsis and were further divided into the group of community-acquired infection and the group of hospital-acquired infection according to the place of onset. RESULTS Among the pathogens for neonatal septicemia, gram-negative bacteria were predominant （73 strains, 60. 33 %）, followed by gram-positive bacteria （44 strains, 36.36 %） and fungi （4 strains, 3.31%）. There was significant difference in comparison of Escherich- ia coli , Klebsiella pneumonia, Acinetobacter baumannii , Enterobacter cloacae, Staphylococcus aureus , Candida albicans, and Streptococcus between the group of early-onset neonatal sepsis and the group of late-onset neonatal sepsis （P〈0. 05）. There was significant difference in comparison of E. coli, K. pneumonia, S. maltophilia, S. aureus, C. albicans between the group of community-acquired infection and the group of hospital-acquired infection. The detection rate of ESBLs producing E. coli and K. pneumonia was 15. 79% and 16. 67% respectively. Gram-negative and gram-positive bacteria were both resistant to penicillin and ampicillin. CONCLUSION There were different compositions of pathogens between early-onset and late-onset neonatal sepsis, as well as between community-acquired and hospital-acquired infection which were all associated with multiple resistant bacteria produced.