新生儿不同病原菌相关血流感染的耐药特征及感染指标差异分析

Differential Analysis of Drug Resistance and Inflammatory Indexes in Neonates with Bloodstream Infection by Different Pathogens

目的分析苏州大学附属儿童医院新生儿血流感染(BSI)相关病原菌的分布、耐药性特征及感染指标改变。方法回顾性统计分析苏州大学附属儿童医院2016年—2022年血培养阳性的新生儿BSI的病原菌分布及其耐药性特点,并进一步分析不同病原菌群BSI患儿感染指标水平差异。结果共分离得到255株细菌,其中革兰阴性菌119株(46.67%),以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌120株(47.06%),以凝固酶阴性葡萄球菌(CoNS)和无乳链球菌居多。大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率分别为26.15%和53.13%。大肠埃希菌对头孢菌素的总体耐药率多低于25%,对部分加酶抑制剂的抗菌药物的敏感性良好;肺炎克雷伯菌头孢菌素类药物耐药率较高(>50%),但对碳青霉烯类抗菌药物的敏感性目前仍较好(<16%)。金黄色葡萄球菌和CoNS对甲氧西林的耐药率分别为7.84%和60.78%,但两者对万古霉素和利奈唑胺均高度敏感。革兰阴性菌组PCT的水平明显高于革兰阳性菌组(P=0.005)。ROC分析结果显示PCT对新生儿BSI的诊断效能最高(AUC:0.836,P<0.001),灵敏度和特异度分别为64.6%和91.5%;同时对革兰阴性菌感染的诊断效能也较好(AUC:0.606,P=0.005),灵敏度和特异度分别为55.5%和71.3%。结论新生儿BSI病原菌分布和耐药特征与成人有显著差异。选择合适的感染指标检测可指导临床选择合适的抗菌药物治疗方案,以期有效降低新生儿BSI死亡率和抗菌药物耐药性。

Objective To analyze the distribution,drug resistance characteristics and infection index changes of pathogens associated with neonatal bloodstream infectiom(BSI)Children's Hospital of Soochow University.Methods Retrospective analysis of distribution of pathogenic bacteria and their drug resistance characteristics of neonatal BSI in Children's Hospital of Soochow University from 2016 to 2022 was performed.The difference of infection indicators in neonates with BSI by different pathogens was further analyzed.Results 255 bacterial strains were identified,of which 119 strains(46.67%)were Gram-negative bacteria,with Escherichia coli and Klebsiella pneumoniae predominating.There were 120(47.06%)strains of Gram-positive bacteria,with Coagulase-negative Staphylococci(CoNS)and Streptococcus Lactis predominating.The detection rates of ESBLs in Escherichia coli and Klebsiella pneumoniae were 26.15%and 53.13%,respectively.The overall resistance rate of Escherichia coli to cephalosporins was majority below 25%,while the susceptibility to the part of additive enzyme inhibitor antimicrobial agents was good.Klebsiella pneumoniae had a high resistant rate to cephalosporins(>50%).However the susceptibility to carbapenem antimicrobials retained good(<16%).The methicillin resistance rate in Staphylococcus aureus and CoNS was 7.84%and 60.78%respectively,but they were both highly susceptible to vancomycin and linezolid.The level of PCT in the Gram-negative group was significantly higher than that in the Gram-positive group(P=0.005).ROC analysis showed that PCT had the highest diagnostic efficacy for neonatal BSI(AUC:0.836,P<0.001),with sensitivity and specificity of 64.6%and 91.5%respectively.It also had better diagnostic efficacy for Gram-negative infections(AUC:0.606,P=0.005),with a sensitivity and specificity of 55.5%and 71.3%respectively.Conclusion The distribution and resistance characteristics of neonatal BSI pathogens are significantly different from those of adults.Selection of appropriate infection indicator tests may guide clinical selection of appropriate antimicrobial drug treatment regimens,to effectively reduce neonatal BSI mortality and antimicrobial drug resistance.