我院新生儿感染常见病原菌及抗菌药物治疗分析

Analysis of common pathogens and antibacterial drugs in neonatal infection in our hospital

目的了解并分析我院新生儿细菌培养阳性及药敏试验特点、抗菌药物治疗及转归情况等,为临床诊断、初始治疗、抗菌药物选择提供参考依据。方法回顾性分析2018年1～6月于内蒙古自治区妇幼保健院新生儿科出院的36例细菌培养阳性患儿抗感染治疗的临床资料。结果 36例患儿共培养出41株病原菌,以革兰阴性菌(G-菌)为主(61.0%),其中又以阴沟肠杆菌居多(29.3%)。药敏试验结果显示,G-菌对头孢吡肟、哌拉西林他唑巴坦钠、亚胺培南、庆大霉素、阿米卡星、妥布霉素、呋喃妥因敏感度较高。革兰阳性菌(G+菌)对万古霉素、奎奴普丁、利奈唑烷、呋喃妥因、利福平敏感度高。大部分患儿给予敏感药物治疗,症状好转或治愈。结论目前我院新生儿感染仍以G-菌的阴沟肠杆菌、肺炎克雷伯菌居多,应在病原学检查完成前,根据患儿症状、产妇情况及我院细菌耐药监测给予经验治疗,在获得药敏报告后,准确评估患儿的用药情况及症状体征,考虑是否换药,给予精准治疗。

Objective To understand and analyze the characteristics of neonatal bacterial culture positivity and drug sensitivity test,antibacterial drug treatment and prognosis in our hospital,so as to provide reference for clinical diagnosis,initial treatment and antibacterial selection.Methods The clinical data of anti-infective treatment of 36 cases of bacterial culture-positive children discharged from the neonatology department of Inner Mongolia Autonomous Region Maternal and Child Health Hospital from January to June 2018 were retrospectively analyzed.Results A total of 41 strains of pathogenic bacteria were cultured in 36 children,mainly with Gram-negative bacteria(G-bacteria)accounting for 61.0%,and most of them were Enterobacter cloacae accounting for 29.3%.The results of drug sensitivity test showed that G-bacteria had higher sensitivity to Cefepime,Piperacillin Tazobactam Sodium,Imipenem,Gentamicin,Amikacin,Tobramycin and Nitrofurantoin.Gram-positive bacteria(G+bacteria)were in high sensitivity with Vancomycin,Quinupristin,Linezolid,Nitrofurantoin,and Rifampicin.Most children were treated with sensitive drugs and their symptoms were improved or cured.Conclusion Currently,neonatal infection in our hospital is still dominated by G-bacteria including Enterobacter cloacae and Klebsiella pneumoniae.Before the completion of the pathogen examination,empirical treatment should be given based on the symptoms of the children,the maternal condition and the bacterial resistance monitoring in our hospital.After obtaining the drug sensitivity report,precise treatment should be applied after accurate assessment of the drug use,symptoms and signs of the children with the consideration of drug change.