福州市新生儿宫内感染临床分析

Analysis on neonatal intrauterine infection in Fuzhou city

目的探讨新生儿宫内感染的病原菌谱及耐药情况。方法将2014年1月-2015年6月期间,在福州市两家三甲医院住院治疗的具有围产期感染高危因素的新生儿血液标本进行相应的血培养、病原菌鉴定及药敏分析。结果窒息史、宫内窘迫、羊水粪染及胎膜早破≥12 h是新生儿宫内感染的重要危险因素。共有126例新生儿血培养结果阳性,病原菌前3位依次为:表皮葡萄球菌40例(31.75%)、大肠埃希菌21例(16.67%)、无乳链球菌18例(14.29%);药敏试验显示,表皮葡萄球菌对β-内酰胺类抗生素耐药率高,对莫西沙星等抗生素敏感;无乳链球菌对青霉素等大部分抗生素敏感;大肠埃希菌及肺炎克雷伯菌对氨苄西林舒巴坦等大部分抗生素药物敏感。结论福州市新生儿宫内感染以革兰阳性菌为主,且耐药程度高,临床医生可根据常见病原菌谱及药敏试验结果给予抗感染治疗。

Objective To explore the bacterial spectrum and drug resistance of neonatal intrauterine infection in Fuzhou city.Methods From January 2014 to June 2015,the blood samples of the neonates with high-risk perinatal infection factors and treated in two hospitals in Fuzhou were collected for blood culture,pathogenic identification and drug sensitive analysis. Results The history of asphyxia,fetal distress,meconium-staining amniotic fluid and premature rupture of amniotic fluid≥12 hours were risk factors of neonatal intrauterine infection,126 neonates were found with positive result,the top three pathogens were Staphylococcus epidermidis（ 40 cases,31. 75%）,Escherichia coli（ 21 cases,16. 67%） and Streptococcus agalactiae（ 18 cases,14. 29%）. Drug sensitivity test showed that the resistance rate of Staphylococcus epidermidis to β-lactam antibiotics was high,Staphylococcus epidermidis was sensitive to antibiotics such as moxifloxacin; Streptococcus agalactiae was sensitive to penicillin and other antibiotics; Escherichia coli and Klebsiella pneumoniae were sensitive to ampicillin,sulbactam and other antibiotics. Conclusion The main pathogen of neonatal intrauterine infection in Fuzhou city was Gram-positive bacteria,and the drug resistance rate was high. The clinicians can give empirical anti-infection therapy according to the common pathogenic bacteria spectrum and drug sensitivity results.