某三甲医院新生儿败血症患儿病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance in patients with neonatal sepsis from a Third-Class A Hospital

目的分析三甲医院郑州大学附属儿童医院新生儿诊疗中心收治的新生儿败血症患儿的血培养阳性病原菌的分布及耐药情况,以指导临床合理用药。方法回顾性分析2015年1月1日至2019年6月30日在该院新生儿败血症患儿病原菌分布及耐药情况并进行统计分析。结果该院新生儿诊疗中心包括新生儿内科病区、新生儿重症监护病区(NICU)、早产儿重症监护病区(PIICU)血培养共检出阳性病原菌575株。575株病原菌中以革兰阳性(G+)菌为主[55.1%(317/575)],其次为革兰阴性(G-)菌[37.6%(216/575)]、真菌[7.3%(42/575)];多重耐药菌(MDRO)构成比为58.6%(337/575)。该诊疗中心血培养排名前5位病原菌分别为表皮葡萄球菌149株(25.9%),肺炎克雷伯菌103株(17.9%),大肠埃希菌56株(9.7%),溶血葡萄球菌36株(6.3%),人葡萄球菌34株(5.9%)。各病区中G+菌构成比新生儿内科最高、G-菌构成比PIICU最高、真菌构成比PIICU最高。各病区不同病原菌构成比比较,差异有统计学意义(P<0.05)。各病区血培养共检出MDRO 337株,耐药率58.6%。结论加强对血培养病原菌及多重耐药菌监测,对指导新生儿败血症临床合理用药及医院感染控制具有重要意义。

Objective To analyze the distribution and drug resistance of blood culture-positive pathogenic bacteria in neonatal septicemia children admitted to the Neonatal Diagnosis and Treatment Center of Children's Hospital Affiliated to Zhengzhou University,which is a third-class A hospital,in order to guide clinical rational drug use.Methods The distribution of pathogenic bacteria and drug resistance of neonatal sepsis in the hospital from January 1,2015 to June 30,2019 were analyzed retrospectively and statistically analyzed.Results A total of 575 positive pathogenic bacteria were detected in blood culture of neonatal medical unit,neonatal intensive care unit(NICU)and premature infant intensive care Unit(PIICU).Among the 575 strains,Gram-positive(G+)bacteria were the main ones[55.1%(317/575)],followed by Gram-negative(G-)bacteria[37.6%(216/575)]and fungi[7.3%(42/575)].The composition of multi-drug resistant organisms(MDRO)was 58.6%(337/575).The top 5 pathogenic bacteria in blood culture were 149(25.9%)strains of Staphylococcus epidermiis,103(17.9%)strains of Klebsiella pneumoniae,56(9.7%)strains of Escherichia coli,36(6.3%)strains of Staphylococcus haemolyticus and 34(5.9%)strains of human staphylococcus.In each ward,the G+bacterial composition ratio was the highest in neonatal internal medicine,The G-bacterial composition ratio PIICU and the fungal composition ratio PIICU.The difference of pathogen composition ratio was statistically significant(P<0.05).A total of 337 strains of MDRO were detected by blood culture in each ward,and the drug resistance rate was 58.6%.Conclusion Monitoring the distribution of pathogenic bacteria and multi-drug resistance in blood culture is of great importance for stratifying the treatment strategies for neonatal sepsis as well as for the control of nosocomial infection.