新生儿血培养病原菌分布及耐药性分析

Distribution and antibiotics resistance analysis of bacteria isolated from blood in neonates

目的分析新生儿病房血培养标本来源病原菌分布及药敏状况,为临床合理使用抗菌药物提供依据。方法回顾南方医科大学附属佛山市妇幼保健院新生儿科2010-2014年全部血培养标本结果,常规方法培养分离血标本中的细菌,用MIC法测定细菌药物敏感性,所有数据使用WHONET 5.6进行汇总分析。结果血标本来源分离出细菌406株,前5位菌种为表皮葡萄球菌(39.90%)、溶血葡萄球菌(10.10%)、无乳链球菌(8.13%)、大肠埃希菌(8.13%)及肺炎克雷伯菌(7.39%)。葡萄球菌对青霉素的耐药率为100.00%,凝固酶阴性葡萄球菌对苯唑西林的耐药率>85.00%,金黄色葡萄球菌对苯唑西林的耐药率为25.00%,对万古霉素、替考拉宁敏感,未检出耐万古霉素金黄色葡萄球菌;无乳链球菌对青霉素、万古霉素敏感;大肠埃希菌和肺炎克雷伯菌对氨苄西林、哌拉西林等常见抗菌药物耐药率高,对碳青霉烯类、喹诺酮类及阿米卡星敏感,对三代、四代头孢菌素、氨曲南、复方磺胺等抗菌药物产生了不同的耐药性。结论 2010-2014年该院新生儿科血培养标本以革兰氏阳性球菌为主,大肠埃希菌和肺炎克雷伯菌是主要的革兰氏阴性菌且对部分抗菌药物的耐药性有差异。临床医生应结合本地近年来病原菌及耐药特点给予合理治疗,并根据培养结果进行调整。

Objective To explore the distribution and antibiotics resistance of bacteria isolated from blood in neonates,and provide an evidence for rational use of antibiotics in clinical practice.Methods The results of blood samples in Department of Neonatology in the hospital from 2010 to 2014 were analyzed retrospectively,the pathogenic bacteria were isolated from blood by routine method.MIC test was used to detect antimicrobial sensitivity.WHONET5.6 software was employed for the analysis of bacterial sensitive data.Results A total of 406 strains of pathogens were identified,of which the first five isolation rate of pathogenic bacteria were Staphylococcus epidermidis（39.30%）,Hemolytic staphylococci（10.10%）,Streptococcus agalactiae（9.13%）,Escherichia coli（8.13%）,and Klebsiella pneumoniae（7.39%）.The drug resistance rate of Staphylococcus bacteria to penicillin was 100%,the drug resistance rates of Escherichia coli and Klebsiella pneumoniae to oxazocilline were more than 85.00%.The drug resistance rate of Staphylococcus aureus to oxazocilline was 25.00%,Staphylococcus aureus was sensitive to vancomycin and teicoplanin,Staphylococcus aureus resistant to vancomycin was not detected.Streptococcus agalactiae was sensitive to penicillin and vancomycin;Escherichia coli and Klebsiella pneumoniae were resistant to commonly used antibiotics,but they were sensitive to carbapenems,quinolones and amikacin,which were resistant to third-generation cephalosporins,fourth-generation cephalosporin,aztreonam,cotrimoxazole and other drugs in different degrees.Conclusion The dominant pathogens in positive blood cultures among neonatal patients in the hospital are Gram-positive cocci,Escherichia coli and Klebsiella pneumoniae are the main Gram-negative bacteria.The resistance rates to some antimicrobials are significantly different between Escherichia coli and Klebsiella pneumoniae.Earlier empiric treatment should choose antibiotics according to local distribution of etiological agents and drug sensitive rate to bacteria.The therapy would be readjusted in accordance with the results of blood culture.