新生儿大肠埃希菌败血症耐药性及抗菌药物治疗分析

Drug Resistance and Antibiotic Treatment of Neonatal Sepsis Induced by Escherichia Coli

目的:分析新生儿大肠埃希菌败血症的药物敏感特点,为选择抗菌药物提供参考。方法:选取重庆医科大学附属儿童医院2011年1月至2018年9月血培养确诊为大肠埃希菌败血症的152例新生儿药敏结果进行回顾性分析。根据败血症发生时间分早发组(<3 d)及晚发组(≥3 d);根据是否产超广谱β-内酰胺酶(ESBLs)分ESBLs(+)组与ESBLs(-)组;根据胎龄(GA)分早产儿组(GA<37周)与足月儿组(GA≥37周)。结果:产超广谱β-内酰胺酶(ESBLs)阳性率晚发组(55.6%)与早发组(43.4%)比较差异无统计学意义(P>0.05);早产儿组(70.4%)高于足月儿组(40.8%),差异有统计学意义(P<0.05)。大肠埃希菌对β-内酰胺类尤其头孢菌素类耐药率较高,对β-内酰胺酶抑制剂复合制剂、碳青霉烯类、氨基糖苷类耐药率较低(4.9%~17.1%),对阿米卡星耐药率为0。ESBLs(+)菌株对多类型抗菌药物耐药率高于ESBLs(-)菌株,差异有统计学意义(P<0.05)。结论:早产儿ESBLs阳性率更高,多重耐药大肠埃希菌逐年增加;新生儿大肠埃希菌败血症尤其是ESBLs(+)菌株感染,可首选含β-内酰胺酶抑制剂复合制剂或碳青霉烯类抗菌药物。

Objective:To analyze the drug sensitive characteristics of neonatal sepsis induced by Escherichia coli,so as to provide reference for the selection of antibiotics.Methods:The drug sensitivity results of 152 neonates with sepsis induced by E.coli in Children’s Hospital of Chongqing Medical University from Jan.2011 to Sept.2018 were retrospectively analyzed.According to the time of sepsis occurrence,all patients were divided into the early onset group(<3 d)and the late onset group(≥3 d);according to production of extended-spectrumβ-lactamases(ESBLs),all patients were divided into the ESBLs(+)group and the ESBLs(-)group;according to gestational age(GA),all patients were divided into the preterm infant group(GA<37 weeks)and the term infant group(GA≥37 weeks).Results:The positive rate of ESBLs in the late onset group(55.6%)was not significantly different from that in the early onset group(43.4%,P>0.05).The positive rate of ESBLs in the preterm infant group(70.4%)was higher than that in the term infant group(40.8%),and the difference was statistically significant(P<0.05).E.coli had higher resistance rate toβ-lactamides,especially cephalosporins,and lower resistance rate to antibiotics containingβ-lactamase inhibitors,carbapenem and aminoglycoside(4.9%~17.1%),and there was no resistance to amikacin.The drug resistance rate of ESBLs(+)strain was higher than that of ESBLs(-)strain,with statistically significant difference(P<0.05).Conclusion:The positive rate of ESBLs in preterm infants is higher,and multi-drug resistant E.coli is increasing year by year.Antibiotics containingβ-lactamase inhibitors and carbapenems should be considered as the best choice in the treatment of neonatal sepsis induced by E.coli,especially for the E.coli of ESBLs(+).