新生儿败血症病原菌分布及耐药性研究

Studies on distribution and drug resistance of pathogenic bacteria of neonatal septicemia

目的:分析新生儿败血症病原菌的分布及耐药性,为临床治疗提供依据。方法:选择2015年3月-2017年3月在河南省洛阳市妇女儿童医疗保健中心进行治疗的106例新生儿败血症患儿为研究对象,所有患儿均进行血培养和药敏试验,分析病原菌的分布和耐药性。结果:在106例患儿的静脉血中分离出病原菌共112株,其中,革兰阳性菌48株(42.85%),革兰阴性菌62株(55.36%),真菌2株(1.79%)。革兰阳性致病菌主要是表皮葡萄球菌、无乳链球菌以及金黄色葡萄球菌;葡萄球菌对青霉素类抗生素的耐药性很高,对万古霉素敏感;无乳链球菌对青霉素类敏感性较高;革兰阴性致病菌主要是肺炎克雷伯菌、大肠埃希菌以及阴沟肠杆菌,均对复合制剂(含β-内酰胺酶抑制剂)、碳青霉烯类药物的敏感率较高;真菌2株均为白假丝酵母菌。结论:在新生儿败血症的治疗中,葡萄球菌感染可采用万古霉素治疗,无乳链球菌感染可首选青霉素治疗,革兰阴性致病菌可采用β-内酰胺酶抑制剂和碳青霉烯类药物治疗。

Objective： To investigate and analyze the distribution and drug resistance of pathogenic bacteria of neonatal septicemia for providing the basis for clinical treatment. Methods： One hundred and six children with neonatal septicemia admitted in Luoyang Maternal and Child Health Care Center from Mar. 2015 to Mar. 2017 were selected as the subjects of present study, the hemoculture and drug sensitivity test were performed, and the distribution and drug resistance of pathogenic bacteria were then analyzed. Results： One hundred and twelve strains of pathogenic bacteria were isolated from patients’ hemoculture, including 48 strains （42.85%） of Gram-positive bacteria, 62 strains （55.36%） of Gram-negative bacteria and 2 strains of fungi （1.79%）. The main Gram-positive bacteria were Staphylococcus epidermidis, Streptococcus agalactiae and Staphylococcus aureus. Staphylococcus sp. showed rather high resistance to penicillin, but sensitive to vancomycin, while Streptococcus agalactiae was rather sensitive to penicillin. The main Gram-negative bacteria were Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae; they were rather sensitive to beta lactamase inhibitors and carbapenems. The two strains of fungi were Candida albicans. Conclusions： For treatment of neonatal septicemia, vancomycin can be used to resist staphylococcus infection. Penicillin is preferred for resisting streptococcus agalactiae. Gram-negative bacteria infection can be treated with beta lactamase inhibitor and carbapenems antibiotics.