新生儿血培养主要病原菌分布及耐药性研究

Study on distribution and drug resistance of major pathogenic bacteria cultured in blood of newborns

目的为新生儿败血症诊断及规范抗生素使用提供依据。方法回顾性分析2015年1月至2018年12月,淄博市妇幼保健院新生儿病区送检的2982例血培养样本,对血培养的阳性样本的病原菌构成分布以及耐药性分析。结果分离病原菌694株,其中G^+球菌477株(68.73%),G^-杆菌204株(29.39%);真菌13株(1.88%)。G^+球菌主要为表皮葡萄球菌167株(24.06%)、溶血葡萄球菌118株(17.00%)、肠球菌48(6.92%)、人葡萄球菌35株(5.04%)和金黄色葡萄球菌28株(4.03%)。G^-杆菌主要为大肠埃希菌93株(13.40%)、肺炎克雷伯菌45株(6.48%)、鲍曼不动杆菌31株(4.47%)和黏质沙雷菌19株(2.74%)为主。表皮葡萄球菌和溶血葡萄球菌对青霉素G、红霉素和氨苄西林的耐药率在90.00%以上(肠球菌对青霉素G除外),未发现G^+球菌对万古霉素、利奈唑胺等抗菌药物的耐药。大肠埃希菌和肺炎克雷伯对氨苄西林、氨苄西林/舒巴坦、头孢类等抗菌药物的耐药率在70.00%~90.00%,鲍曼不动杆菌对氨苄西林的耐药率为100.00%。G^-杆菌对环丙沙星、左氧氟沙星、庆大霉素等抗菌药物的耐药率最低。结论新生儿血培养病原菌耐药性差异较大并有多重耐药现象。应加强对血培养病原菌构成和耐药性分析,规范抗菌药物使用,减少院内感染。

Objective To discuss the distribution and drug resistance of major pathogenic bacteria cultured in blood of sick newborns,and to provide evidence for the diagnosis and antibiotic treatment of neonatal septicemia(NS).Methods From January 2015 to December 2018,2982 blood samples were collected from sick newborns in neonatal ward of Maternal and Child Health Hospital of Zibo and were cultured,drug sensitive test was performed for culture positive samples.Results A total of 694 strains of pathogenic bacteria were isolated,including 477 strains of Gram-positive(G^+)cocci,204 strains of Gram-negative bacilli(Gram-negative)and 13 strains of fungi.The predominant G^+cocci were Staphylococcus epidermidis(24.06%),Staphylococcus haemolyticus(17.00%),Enterococci(6.92%),Staphylococcus aureus(5.03%)and Staphylococcus aureus(4.03%),while the predominant G^-bacilli were Escherichia coli(13.40%),Klebsiella pneumonia(6.48%),Acinetobacter baumannii(4.47%)and Serratia mucosae(2.74%).The drug resistance rate of Staphylococcus epidermidis and Staphylococcus haemolyticus to penicillin G,erythromycin,and ampicillin was more than 90.00%(exclude enterococci to penicillin G),no G^+cocci was found to be resistant to antibiotics such as vancomycin and linazolam.The drug resistance rates of Escherichia coli and Feiyankeleibo to antibiotics as ampicillin,ampicillin/Schubatan,and cefs ranged from 70.00%to 90.00%,and the resistance rate of Baumannacter to ampicillin was 100.00%.G^-bacillus had the lowest resistance to antibiotics such as ciprofloxacin,levofloxacin,and gentamycin.Conclusions The drug resistance to antibiotics of pathogenic bacteria cultured from neonatal blood samples vary significantly and there is multiple drug resistanceh.Therefore,it is necessary to perform the analysis on bacteria distribution and drug resistance test which is of great significance to standardize the use of antibiotics and reduce hospital infection.