连续7年15424份新生儿血培养结果分析

Analysis of bacterial resistance from 15 424 neonatal blood cultures for seven consecutive years

目的:探讨15 424份新生儿血培养阳性菌谱构成特点,为预防新生儿败血症及合理使用抗生素提供临床参考。方法:回顾性分析2009-2015年新生儿送检血液培养结果,整理培养阳性细菌种类,采用Whonet5.4软件分析新生儿败血症重要病原菌对抗菌素的敏感性。结果:连续7年共送检15 424份新生儿血培养,其中阳性结果883份,平均血培养阳性率为5.7%。菌种分类构成比为:革兰阳性菌61.8%,革兰阴性菌37.6%,真菌0.6%。前6位病原菌分别为:凝固酶阴性葡萄球菌(CNS)432株、大肠埃希菌(ECO)74株、嗜麦芽黄单胞菌(PMA)71株、肺炎克雷伯菌(KPN)70株、无乳链球菌(GBS)42株、金黄色葡萄球菌(SAU)36株,其中CNS甲氧西林耐药率85.9%,SAU中34.4%为耐甲氧西林金黄色葡萄球菌(MRSA),GBS四环素耐药率100%,红霉素耐药率80%,ECO产超广谱β-内酰胺酶(ESBL)率35.9%,KPN产ESBL率60%。结论:新生儿血培养阳性菌种类多,出现多重耐药比例高,需定期总结回顾病原菌流行分布并分析耐药性,为临床防治新生儿败血症及合理用药提供参考和依据。

Objective：To investigate the characteristics of positive bacterial spectrum of blood culture in 15 424 newborns and provide the reference for the prevention of neonatal sepsis and rational use of antibiotics. Method：All submitted neonatal blood culture results were retrospectively analyzed during the period of 2009 to 2015. Then the species of positive blood culture bacterium were identified and the antibiotics sensitivity results of the bacterium which were the main cause of neonatal sepsis were analyzed by using Whonet5.4 programme. Result： 15 424 cases of neonatal blood culture results were collected in nearly seven years, in which 883 cases were positive results. The average positive rate of blood culture was 5.7%. The constituent ratio of strain was 61.8% Gram-positive bacteria, 37.6% gram-negative bacteria, and 0.6G yeastqike fungi. Coagulase Negative Staphylococcus （CNS） 432 strain, Escherichia Coli （ECO） 74 strain, Pseudomonas Maltophilia （PMA）, 71 strains Klebsiella Pneumonias （KPN） 70 strain, Group B Streptococcus （GBS） 42 strains and Staphylococcus Aureus （SAU） 36 strain were the top six pathogens. The methicillin resistance rate of CNS was 85.9% and 34.4% SAU was methicillin-resist- ant staphylococcus aureus （MRSA）. The tetracycline and erythromycin resistance rates of GBS were 100~ and 80G, respectively. ESBL production rates of ECO and KPN were 35. 9% and 60%, individually. Conclusion： There are variety species of newborn blood culture positive bacteria. The proportion of multiple resistant bacterium appears to be high. To provide important clinical reference and scientific basis for the prevention or treatment of neonatal sepsis and the rational use of medicines, the prevalence and distribution of pathogens should be reviewed and the drug resistance situation need to be analyzed regularly.