233例新生儿脓毒血症患儿的病原菌分布及耐药性分析

Analysis of Distribution and Drug Resistance of Pathogens Derived from 233 Infants with Neonatal Sepsis

目的:分析新生儿脓毒血症(NS)的病原菌分布及耐药性。方法:收集9415例新生儿科住院患儿的临床资料,选取其中确诊NS的住院新生儿233例,分为早产儿组(胎龄<37周,n=131)和足月儿组(胎龄≥37周,n=102),收集2组NS患儿的性别、胎龄及出生体质量、围产期因素、临床症状及临床结局资料并比较,于使用抗生素前抽取2组NS患儿静脉血各1~3 mL,采用血液细菌培养法进行血培养菌株鉴定及药敏试验。结果:不同胎龄和出生体质量的住院新生儿NS发生率差异均有统计学意义(P<0.01);早产儿组NS患儿发生胎膜早破、羊水污染、呼吸暂停、反应差、放弃治疗和死亡比例高于足月儿组(P<0.05),但发生黄疸、体温异常及治愈比例均低于足月儿组(P<0.05);233例NS中检出病原菌105株,革兰阳性菌52株(49.52%)且以表皮葡萄球菌(46.15%)为主,革兰阴性菌48株(45.71%)且以大肠埃希菌(37.50%)和肺炎克雷伯杆菌(33.33%)为主,真菌5株(4.76%)均为白假丝酵母菌;革兰阳性菌对万古霉素和利奈唑胺、革兰阴性菌对亚胺培南及真菌对常见抗真菌药物均未发现耐药。结论:新生儿脓毒血症的病原菌以革兰阳性菌所占比例较大,未发现对万古霉素和利奈唑胺耐药,革兰阴性菌未发现对亚胺培南耐药。

Objective: To investigate the distribution and drug resistance of pathogens from infants with neonatal sepsis( NS). Methods: The clinical data of 9 415 hospitalized infants were collected.Among them,233 infants diagnosed as NS were selected and divided into preterm infant( gestational age < 37 weeks,n = 131) and term infant( gestational age≥37 weeks,n = 102) groups. The infant gender,gestational age,birth weight,perinatal factors,clinical symptoms and clinical outcomes were collected and compared. Before antibiotics treatment,1-3 m L venous blood/infant were taken to identify blood bacterial strains and test drug sensitivity by culturing blood bacterial method. Results:The incidences of NS were significantly different among neonates with different gestational age or different birth weight( P < 0. 01). The rates of premature rupture of membranes,amniotic fluid pollution,apnea,poor response,abandonment of treatment and death were higher in preterm infant group than those in term group( P < 0. 05),but the incidence of jaundice,temperature abnormality and cure were lower in preterm infant group than those in term group( P < 0. 05). One hundred and five strains of pathogenic bacteria were detected from the 233 NS infant blood culture. Among them,gram-positive bacteria had 52( 49. 52%) strains in which staphylococcus epidermidis accounted for46. 15%,and gram-negative bacteria 48( 45. 71%) strains in which Escherichia coli accounted for37. 50% and Klebsiella pneumoniae 33. 33%. Besides,identified five fungi( 4. 76%) were Candida albicans. Gram-positive bacteria were not resistant to vancomycin and linezolid,similarly,gramnegative bacteria were not resistant to imipenem,and fungi were not resistant to common antifungal drugs. Conclusion: The pathogenic bacteria from infants with NS were mainly gram-positive bacteria.No resistance was observed in gram-positive bacteria to vancomycin,linezolid,and gram-negative bacteria to imipenem.