贵州黔南地区新生儿败血症的病原菌分布特点、耐药性及危险因素分析

Distribution characteristics and drug resistance of pathogens in neonatal sepsis and its risk factors in Qiannan, Guizhou Province, China

目的:探讨贵州黔南地区新生儿败血症的病原菌分布特点、耐药性及危险因素。方法:选取贵州医科大学第三附属医院2015年9月至2018年10月收治的87例临床及血培养证实为新生儿败血症的患儿设为观察组,另取同期收治的81例无败血症新生儿为对照组。回顾查阅两组新生儿临床资料,87例败血症患儿另接受病原菌检测,明确其病原菌分布特点,并针对临床常用抗生素进行药敏试验。结果:①病原菌分布特点:87例败血症患儿共检出96株病原菌,其中9例存在复合细菌感染;革兰阳性菌占40.63%(主要有表皮葡萄球菌、金黄色葡萄球菌、无乳链球菌),革兰阴性菌占57.29%(主要有大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌),真菌占2.08%。②病原菌耐药性分析:表皮葡萄球菌、金黄色葡萄球菌、无乳链球菌对万古霉素、利福平、替考拉宁、利奈唑胺、米诺环素完全敏感;大肠埃希菌及肺炎克雷伯菌对亚胺培南、美罗培南完全敏感,对氨苄西林耐药性较高;肺炎克雷伯菌对氨苄西林完全耐药;阴沟肠杆菌对阿米卡星、亚胺培南、美罗培南等完全敏感,对氨苄西林、头孢唑林、头孢西丁、头孢呋辛完全耐药。③危险因素分析:早产胎龄<34周,出生体重<1.5 kg,住院时间> 2周,新生儿窒息、肺部感染、脐部感染及胎膜早破,母体产前发热是新生儿败血症发生的高危因素(P <0.05)。结论:本地区新生儿败血症以大肠埃希菌、表皮葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌等感染为主。早产胎龄<34周,出生体重<1.5 kg,住院时间> 2周,新生儿窒息、肺部感染、脐部感染及胎膜早破,母体产前发热是导致新生儿败血症发生的独立危险因素。

Objective: To investigate the distribution characteristics and drug resistance of pathogens in neonatal sepsis and its risk factors in Qiannan, Guizhou Province, China. Methods: Eighty-seven neonates with sepsis who were admitted to The Third Affiliated Hospital of Guizhou Medical University in Qiannan from September 2015 to October 2018 were enrolled in the observation group. Eighty-one neonates without sepsis in the same period were enrolled in control group. The clinical data of the two groups were reviewed. The 87 neonates with sepsis were tested for pathogens, and the distribution characteristics of pathogens were identified. The drug sensitivity test was performed for common antibiotics in clinical practice. Results:①Distribution characteristics of pathogenic bacteria: A total of 96 strains of pathogenic bacteria were identified in 87 neonates with sepsis, 9 of whom had complex bacterial infections;Gram-positive bacteria accounted for 40.63%(including Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus agalactiae), Gram-negative bacteria accounted for 57.29%(including Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae), and fungi accounted for 2.08%.② Analysis of drug resistance: S. epidermidis, S. aureus, and Streptococcus agalactiae were completely sensitive to vancomycin, rifampicin, teicoplanin, linezolid, and minocycline. E. coli and K. pneumoniae were completely sensitive to imipenem, meropenem and highly resistant to ampicillin. K. pneumoniae was completely sensitive to ampicillin. E. cloacae was completely sensitive to amikacin, imipenem, and meropenem and completely resistant to ampicillin, cefazolin, cefoxitin, and cefuroxime.③Analysis of risk factors: the following factors were the high-risk factors for neonatal sepsis: gestational age < 34 weeks, birth weight < 1.5 kg, length of hospital stay > 2 weeks, neonatal asphyxia, pulmonary infection, umbilical infection, premature rupture of membranes, and maternal prenatal fever(P < 0.05). Conclusion: The main pathogens of neonatal sepsis in this area are E. coli, S. epidermidis,K. pneumoniae, and S. aureus. Gestational age < 34 weeks,birth weight < 1.5 kg, length of hospital stay > 2 weeks, neonatal asphyxia, pulmonary infection, umbilical infection,premature rupture of membranes, and maternal prenatal fever are independent risk factors for neonatal sepsis.