东莞地区NICU住院新生儿感染的病原菌分布特点

Distribution of pathogens causing neonatal infections in hospitalized neonates in NICU in Dongguan

目的分析东莞地区NICU住院新生儿感染的病原菌分布特点，为临床治疗及用药提供参考。方法收集2011年3月至2017年2月共765份培养阳性标本进行细菌鉴定，分析病原菌分布，不同年份细菌谱变迁及不同日龄新生儿病原菌构成情况。结果2011年3月至2017年2月共送检标本11650份，培养阳性765份，阳性率6．6％；②765株病原菌中，革兰阳性细菌428（55．9％）株。革兰阴性细菌277（36．2％）株。③2011-2014年、2015~2017年前2位菌株及耐药菌株相同。④早期新生儿前3位菌株依次为：表皮葡萄球菌、大肠埃希菌、真菌；其中前3位耐药菌分别为：耐甲氧西林表皮葡萄球菌、耐甲氧西林溶血葡萄球菌、耐甲氧西林人葡萄球菌。晚期新生儿前3位菌株依次为：表皮葡萄球菌、真菌、肺炎克雷伯菌。其中前3位耐药菌分别为：耐甲氧西林表皮葡萄球菌、耐甲氧西林溶血葡萄球菌、产ESBLs大肠埃希菌。结论本地区近年来新生儿感染主要致病菌为表皮葡萄球菌、大肠埃希菌、溶血性葡萄球菌、肺炎克雷伯菌，耐甲氧西林及产超广谱β-内酰胺酶细菌检出率较文献报道低。不同年份细菌谱变化不大。新生儿感染以耐甲氧西林表皮葡萄球菌最常见，除此之外，早期新生儿要注意大肠埃希菌感染，而晚期新生儿要注意肺炎克雷伯菌感染。

Objective This study aimed to describe the distribution of pathogens causing neonatal infections in hospitalized neonates in NICU in Dongguan. Methods Data were collected from March, 2011 to February, 2017 for culture-positive specimens. Distribution of pathogens, changes of pathogens in different years and composition of pathogens in different ages of neonates were analyzed. Results （1）Overall, 11650 specimens were examined from March, 2011 to February, 2017, and 765 （6.6%） were positive cuhured. （2）Of the 765 strains of pathogens, 428 （55.9%） were gram positive, including 184 （24.1%） strains of Staphylococcus epidermidis, 55 （7.2%） strains of Staphylococcus haemolyticus, 41 （5.3%） strains of Staphylococcus hominis and 38 （5.0%） strains of Staphylococcus aureus. The detection rate of methicillin resistance accounted for 56.5% （242/428）. 277 （36.2%） strains were gram negative. （3）The top two pathogens and resistant pathogens were the same from 2011 to 2014 and 2015 to 2017. （4）The top three pathogens were Staphylococcus epidermidis, Escherichia coli and fungi in early neonates, Staphylococcusepidermidis, fungi and Klebsiellapneumonia in late neonates. Conclusions The main pathogens of neonatal infection in local area included Staphylococcus epidermidis, Escherichia coli, Staphylococcus haemolyticus, and Klebsiella Lei Bojun. The detection rate of Methicillin resistant and ESBLswas lower thanthat of other re- ports. The bacterial spectrum changed little in different years. Methicillin resistant Staphylococcus epidermi- dis was most common in neonatal infection. In addition, Escherichia coli and Klebsiellapneumoniawere the second most common pathogen in early neonatal and late neonatal, respectively.