不同海拔地区NICU血培养常见病原菌分布及耐药性的对比分析

Comparative analysis of pathogenic bacteria distribution and drug resistance from NICU blood culture at different altitudes

目的对比分析不同海拔地区新生儿重症监护病房(NICU)血培养阳性病原菌的分布与耐药性的影响因素。方法回顾性分析2015年西藏人民医院(高海拔地区医院)与重庆大坪医院(低海拔地区医院)临床NICU患儿血培养阳性主要病原菌的分布情况与耐药情况。结果 2015年西藏人民医院NICU患儿血培养阳性病原菌中,表皮葡萄球菌19株(18.4%),大肠埃希菌18株(17.5%),肺炎克雷伯菌14株(13.6%),溶血葡萄球菌14株(13.6%),嗜麦芽窄食单胞菌12株(11.7%);重庆大坪医院NICU患儿血培养病原菌主要为表皮葡萄球菌31株(19.7%),木糖氧化产碱杆菌27株(17.2%),溶血葡萄球菌18株(11.5%),肺炎克雷伯菌14株(8.9%),鲍曼不动杆菌14株(8.9%)。西藏人民医院革兰阴性杆菌检出率较高,重庆大坪医院革兰阳性球菌检出率较高,两家医院血培养主要病原菌分布差异有统计学意义(P<0.05)。重庆大坪医院耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、产超广谱β-内酰胺酶(ESBLs)和多重耐药鲍曼不动杆菌(MDRAB)阳性率均明显高于西藏人民医院,血培养主要病原菌耐药情况差异有统计学意义(P<0.05)。结论不同海拔环境因素对NICU患儿血培养病原菌分布及耐药性具有重要的影响作用。

Objective To compare and analyze the influencing factors of the distribution and drug resistance of blood culture positive pathogens in neonatal intensive care unit （NICU） at different altitude areas. Methods The distribution of blood culture positive pathogens and clinical susceptibility of children in NICU of two different altitude hospitals in 2015 were retrospectively ana- lyzed. Results In 2015,children in NICU in upper elevation district hospital mainly infected with 19 strains（18. 4%） of epidermis staphylococcus, 18 strains （ 17.5 % ） of Escherichia coli, 14 strains （ 13.6% ） of Klebsiella pneumoniae, 14 strains （ 13.6 % ） of Hemol- ysis staphylococcus, 12 strains（11.7 % ） of Stenotrophomonas maltophilia;Children in NICU at low altitude hospital mainly infected with 31 strains （ 19.7 %） of epidermis staphylococcus, 27 strains （ 17. 2 % ） of Achromobacter xylosoxidans, 18 strains （ 11.5 %） of Hemolysis staphylococcus, 14 strains（8.9 % ） of Ktebsiella pneumoniae, 14 strains （8.9 %） of Acinetobacter baumannii. The detec- tion rate of Gram-negative bacilli in high-altitude hospital was higher, and the detection rate of Gram-positive cocci in low altitude hospital was higher. In high-altitude district hospital, the detection rate of methicillin-resistant coagulase-negative staphylococci （MRCNS） extended-spectrum 13-1actamase （ESBLs）,and multidrug-resistant Acinetobacter baumannii（MDRAB） were than low al- titude hospital. Conclusion Escherichia eoli and Stenotrophomonas maltophilia detection rate and common antibiotics sensitive rate are relatively high at upper elevation areas ; Detection rate of coagulase negative Staphylococcus aureus and common antibiotics re- sistance rate are high in low altitude. Different altitudes environmental factors may play an important role in pathogens distribution and drug resistance from NICU blood culture.