2013年新生儿重症监护病房病原菌感染情况及耐药性调查与护理防控措施分析

Investigation of the pathogenic bacteria infection and drug resistance in neonatal intensive care unit(NICU) in 2013 and analysis of the prevention and nursing control measures

目的探讨2013年新生儿重症监护病房病原菌感染情况及耐药性调查与防控措施。方法选择我院2013年入住新生儿重症监护病房(NICU)的1764例新生儿为研究对象,对比其送检的9类标本中病原菌的检出率及其耐药性。结果 1本次检出革兰阴性菌53例(36.30%),革兰阳性菌93例(63.70%),其中A组阴性菌检出3例(5.66%),阳性菌检出4例(4.30%),检出率为1.37%(7/510),同B组的11.08%(139/1254)对比差异明显(χ2=45.045,P<0.05);2病原菌检出率最高的大肠埃希菌对四环素、氨苄西林等常见抗菌药物耐药性较强,对美洛培南、氯霉素等药物敏感性较强;检出率位列第二的无乳链球菌对氯洁霉素、红霉素等药物敏感度较低,对头孢呋辛钠、氨苄西林等药物几乎无耐药性;金黄色葡萄球菌及肺炎克雷伯菌均对氨苄西林耐药性较强,临床用药时应避开该类药物以提升疗效。结论大肠埃希菌、无乳链球菌和金黄色葡萄球菌为本院2013年NICU检出率最高的三类病原菌,为有效降低新生儿交叉感染风险,院方应进一步落实NICU管理措施,做好消毒、隔离、监测等常规工作,严格遵循无菌操作原则,控制抗生素给药剂量,为新生儿抵抗力及免疫力的提升创造条件。

Objective To investigate the situation of the pathogenic bacteria and its drug resistance in neonatal inten-sive care unit (NICU) in 2013 and the prevention and control measures. Methods A total of 1764 cases of neonates treated in neonatal intensive care unit in our hospital in 2013 were selected as research objects and the detection rate and drug resistance of pathogenic bacteria of the 9 types of specimens submitted were compared. Results ①The gram negative bacteria which were tested of 53 cases accounted for 36.30% and gram positive bacteria 93 cases accounted for 63.70%; Among which 3 cases of negative bateria were checked out which accounted for 5.66% and 4 cases of positive bateria were checked out which accounted for 4.30%.The detectable rate was 1.37%(7/510). The contrast difference was obvious(χ2=45.045, P<0.05) compared with that 11.08%(139/1254) in group B.②The drug resistance of Escherichia coli, which had the highest detection rate of pathogenic bacteria, against tetracycline, ampicillin and other common antibiotics was stronger and it was more sensitive to meropenem, chloramphenicol and other drugs. The sensitivity of streptococcus agalactiae, whose detection rate was the second, to chlorine lincomycin, erythromycin and other drugs was lower and was almost no resistance to ampicillin, Cefuroxime sodium and other drugs. The resistance of Staphylococcus aurous and Klebsiella pneumonia against ampicillin was stronger. Such drugs as clinical medicine should be avoided to enhance the curative effect. Conclusion Escherichia coli, no Streptococcus and Staphylococcus aurous are highest NICU detection rate of three kinds of pathogenic bacteria in our hospital in 2013. To effectively re-duce the neonatal cross infection risks, the hospital should further implement the NICU management measures, strengthen disinfection and isolation, monitoring, routine work and so on, strictly follow the principle of aseptic opera-tion, control of the amount of antibiotic drug and create conditions for their newborn resistance and immunity enhance-ment.