新生儿败血症病原学分布及耐药性分析

Neonatal sepsis and antibiotic resistance of bacteria and fungi isolated from neonatal blood samples

目的分析近8年住院新生儿败血症构成比、病原菌分布及耐药性特点,为临床治疗提供参考。方法收集2007年1月至2014年12月我院新生儿科收治的败血症患儿临床资料,回顾性分析病原菌分布及耐药情况。结果共收治败血症患儿608例,占同期住院患儿的2.62%(608/23 224),其中确诊412例、临床诊断196例。前4年败血症住院构成比为2.29%(225/9 805),低于后4年的2.85%(383/13 419),差异有统计学意义(P<0.05)。共检出病原菌412株,革兰阳性菌(G^+菌)、革兰阴性菌(G^-菌)及真菌分别占62.38%、30.34%和7.28%。前4年检出病原菌155株,G^+菌、G^-菌及真菌分别为106株(68.39%)、40株(25.81%)、9株(5.81%),其中凝固酶阴性葡萄球菌(CONS)占G^+菌的90.57%,肺炎克雷伯菌及大肠埃希菌分别占G^-菌的50.00%和15.00%。后4年检出病原菌257株,G^+菌、G^-菌及真菌分别为151株(58.75%)、85株(33.07%)、21株(8.17%),其中CONS占G^+菌的74.83%,肺炎克雷伯菌及大肠埃希菌分别占G^-菌的30.58%和35.29%。前、后4年CONS及大肠埃希菌构成比比较,差异有统计学意义(P<0.05)。G^+菌对青霉素G、苯唑西林及大环内酯类普遍耐药,对哌拉西林他唑巴坦、喹诺酮类抗菌药物敏感性高,未发现万古霉素耐药菌株;G^-菌对氨苄西林及头孢菌素类抗菌药物普遍耐药,对β-内酰胺酶抑制剂复方制剂及喹诺酮类较敏感,对碳青霉烯类抗菌药物敏感性高;真菌对康唑类普遍敏感。结论新生儿败血症病原菌以CONS为主,其次为肺炎克雷伯菌及大肠埃希菌;主要G^+菌及G^-菌对青霉素及头孢类抗菌药物普遍耐药,主要G^+菌对万古霉素均敏感,主要G^-菌对碳青霉烯类抗菌药物敏感性高;真菌对康唑类药物普遍敏感。

Objective To study the pathological spectrum of neonatal sepsis and antibiotic resistance of bacteria and fungi isolated from neonatal blood samples. Methods Clinical information of neonates with sepsis admitted to neonatal ward of our Hospital were retrospectively collected from January 2007 to December 2014 and analyzed. Results During the study period, a total of 23 224 infants were admitted to neonatal ward. Among them, 608 were diagnosed with sepsis （2. 62% , 608 / 23 224）. Blood culture samples were positive in 412 cases, the rest （196 cases） were diagnosed according to clinical manifestations and laboratory tests. The composition ratio of sepsis during the first 4 years was significantly lower than that of the subsequent 4 years （2. 58% , 225 / 9 805 vs. 2. 85% , 383 / 13 419, P 〈 0. 05）. Of 412 bacterial strains isolated, gram-positive bacteria, gram-negative bacteria and fungi accounted for 62. 38% , 30. 34% and 7. 28% , respectively. For the 155 strains isolated during first 4 years, the number of G ＋ bacteria, G - bacteria and fungi were 106 strains （68. 39% ）, 40 strains＆amp;nbsp;（25. 81% ）, 9 strains （ 5. 81% ）, respectively. The coagulase-negative staphylococcus （ CONS ） accounted for 90. 57% of G ＋ strains. Klebsiella pneumoniae and Escherichia coli accounted for 50. 00%and 15. 00% of G - strains respectively. 257 strains were isolated during the subsequent 4 years, of which G ＋ bacteria, G - bacteria and fungi accounted for 151 strains （58. 75% ）, 85 strains （33. 07% ）, 21 strains （8. 17% ）, respectively. CONS accounted for 74. 83% of G ＋ strains, Klebsiella pneumoniae and Escherichia coli accounted for 30. 58% and 35. 29% of G - strains. The composition ratio of CONS and Escherichia coli were significantly different between first and subsequent 4 years （P 〈 0. 05）. G ＋bacteria were resistant to penicillin, oxacillin and macrolide, sensitive to piperacillin / tazobactam and quinolone. We did not identify any G ＋ strain resistant to vancomycin. In general, G - bacteria were resistant to ampicillin and cephalosporins, sensitive to the beta lactamase inhibitor compound preparation and quinolones, and highly sensitive to carbapenems. Fungi generally were sensitive to conazoles. Conclusions Neonatal sepsis are mainly caused by CONS, Klebsiella pneumoniae and Escherichia coli also play important roles. G ＋ bacteria and G - bacteria in general are resistant to penicillin and cephalosporins. All G ＋ bacterial strains isolated from our cohort are sensitive to vancomycin. G - bacteria are generally sensitive to carbapenems. Fungi generally are sensitive to conazoles.