中国河北省新生儿败血症病原体构成及耐药性的横断面研究

A cross-sectional study on the pathogen composition and antimicrobial resistance in neonates with sepsis in Hebei Province,China

目的分析河北地区新生儿败血症病原体构成及其耐药特征,为优化区域内新生儿败血症管理策略提供依据。方法前瞻性收集2021年11月1日—2022年12月31日河北省23家医院经血培养证实的新生儿败血症病例资料,分析早发型败血症(early-onset sepsis,EOS)、社区获得性晚发型败血症(community-acquired lateonset sepsis,CALOS)与医院获得性晚发型败血症(hospital-acquired late-onset sepsis,HALOS)患儿病原体构成及其耐药特征。结果共纳入289例患儿,发生292次感染,其中EOS、CALOS及HALOS分别有117例次(40.1%)、95例次(32.5%)及80例次(27.4%)。共分离到294株病原体,其中EOS组分离病原体118株(40.1%),最常见的是大肠埃希菌(39株,33.0%)和凝固酶阴性的葡萄球菌(13株,11.0%);CALOS组分离病原体95株(32.3%),最常见的是大肠埃希菌(35株,36.8%)和B族链球菌(14株,14.7%);HALOS组分离病原体81株(27.6%),最常见的是肺炎克雷伯菌(24株,29.6%)和大肠埃希菌(21株,25.9%)。凝固酶阴性的葡萄球菌对青霉素类抗菌药物的耐药率达80%以上,大肠埃希菌和肺炎克雷伯菌对常用β内酰胺类药物的耐药率为2.2%~75.0%。HALOS组主要的革兰氏阴性菌对常用β内酰胺类药物的耐药率高于CALOS组。结论在河北地区,大肠埃希菌是新生儿EOS与LOS最常见的病原体;不同类型新生儿败血症病原体组成及耐药性存在差异,经验性抗菌药物的选择需依据该地区最新监测数据。

Objective To study the pathogen composition and antimicrobial resistance characteristics in neonates with sepsis in the Hebei area,providing a basis for optimizing the management strategies for neonatal sepsis in the region.Methods The medical data of neonates with sepsis confirmed by blood culture from 23 hospitals in Hebei Province were collected prospectively from November 1,2021 to December 31,2022.The pathogen composition and antimicrobial resistance characteristics were analyzed in early-onset sepsis(EOS),community-acquired late-onset sepsis(CALOS),and hospital-acquired late-onset sepsis(HALOS)cases.Results A total of 289 neonates were included,accounting for 292 infection episodes,with 117(40.1%)EOS,95(32.5%)CALOS,and 80(27.4%)HALOS cases.A total of 294 pathogens were isolated,with 118(40.1%)from the EOS group,where Escherichia coli(39 strains,33.0%)and coagulase-negative staphylococci(13 strains,11.0%)were the most common.In the CALOS group,95 pathogens were isolated(32.3%),with Escherichia coli(35 strains,36.8%)and group B Streptococcus(14 strains,14.7%)being predominant.The HALOS group yielded 81 isolates(27.6%),with Klebsiella pneumoniae(24 strains,29.6%)and Escherichia coli(21 strains,25.9%)as the most frequent.Coagulase-negative staphylococci showed over 80%resistance to penicillin antibiotics.Escherichia coli and Klebsiella pneumoniae showed a resistance rate of 2.2%to 75.0%to commonβ-lactam antibiotics.The resistance rates of predominant Gram-negative bacteria in the HALOS group to commonβ-lactam antibiotics were higher than those in the CALOS group.Conclusions In the Hebei region,Escherichia coli is the most common pathogen in both EOS and LOS.There are differences in the composition and antimicrobial resistance of pathogens among different types of neonatal sepsis. The choice of empirical antimicrobialdrugs should be based on the latest surveillance data from the region.