连续三年新生儿血培养病原菌种类及耐药性

Species and antimicrobial resistance of pathogens from blood culture of neonates for three consecutive years

目的探讨新生儿血培养病原菌分布及其耐药情况。方法回顾性调查2013年1月1日—2015年12月31日某妇幼保健院新生儿重症监护病房(NICU)住院新生儿送检的血培养标本,对血培养及药敏结果采用WHONET5.6软件进行病原菌分布、耐药情况分析。结果血培养标本中共分离菌株255株,包括革兰阴性菌219株(85.88%),革兰阳性菌29株(11.37%),真菌7株(2.75%)。分离细菌主要为肺炎克雷伯菌(157株)、大肠埃希菌(35株)、B族链球菌(13株)。大肠埃希菌对氨苄西林、哌拉西林的耐药率为97.14%、94.29%,对头孢西丁、亚胺培南、美罗培南、厄他培南及阿米卡星均敏感。肺炎克雷伯菌对哌拉西林的耐药率为93.63%,对头孢唑林、头孢呋辛的耐药率为87.90%、85.35%,对阿米卡星敏感。主要革兰阴性菌对酶抑制剂复合制剂(阿莫西林/克拉维酸、替卡西林/克拉维酸)的耐药率均上升,对头孢菌素类药物(头孢他啶、头孢西丁)的耐药率上升,对磺胺类药物(复方磺胺甲口恶唑)的耐药率上升,差异均有统计学意义(均P<0.01)。结论肺炎克雷伯菌和大肠埃希菌在该院NICU血流感染中占重要地位,并对多种抗菌药物的耐药率较高,抗感染治疗的经验性用药应结合本地资料。

ObjectiveTo evaluate the distribution and antimicrobial resistance of pathogens in neonates.MethodsBlood culture specimens from hospitalized neonates in the neonatal intensive care unit(NICU)of a maternal and child heath hospital between January1,2013and December31,2015were investigated retrospectively,blood culture and antimicrobial susceptibility testing results were analyzed with WHONET5.6software.ResultsA total of255strains were isolated from blood culture specimens,including219strains(85.88%)of gram negative bacteria,29strains(11.37%)of gram positive bacteria,and7strains(2.75%)of fungi.The isolated bacteria were mainly Klebsiella pneumoniae(n=157),Escherichia coli(n=35),and Streptococcus B(n=13).Resistance of Escherichia coli to ampicillin and piperacillin were97.14%and94.29%respectively,all were sensitive to cefoxitin,imipenem,meropenem,ertapenem,and amikacin.Resistance rates of Klebsiella pneumoniae to piperacillin,cefazolin,and cefuroxime were93.63%,87.90%,and85.35%respectively,but was sensitive to amikacin.Resistance rates of the main gram negative bacteria to enzyme inhibitor(amoxicillin/clavulanic acid,ticarcillin/clavulanic acid),cephalosporins(ceftazidime,cefoxitin),and sulfonamides(sulfamethoxazole compound)increased,difference were all statistically significant(all P<0.01).ConclusionKlebsiella pneumoniae and Escherichia coli are the major pathogens causing bloodstream infection in NICU,and resistance rates to a multiple antimicrobial agents are high,empirical medication for anti infection treatment should be combined with local data.