CAJ | 학술논문

目的研究新生儿重症监护室(neonatal intensive care unit,NICU)血培养阳性的脓毒症患儿的病原菌分布及耐药情况,为临床合理使用抗生素提供依据.方法回顾性分析2009年1月至2011年7月广东医学院附属医院NICU 1450例新生儿的1450份血培养结果及药敏结果.结果 1450份血培养标本共分离病原菌9种233株,总阳性率为16.1％.其中革兰阳性球菌93株,以凝固酶阴性葡萄球菌占优势,其次为金黄色葡萄球菌;革兰阴性杆菌103株,以肺炎克雷白杆菌居多,其次为大肠埃希菌、鲍曼不动杆菌;真菌37株,以念珠菌为主.革兰阳性球菌对万古霉素、利奈唑胺及替考拉宁敏感性高,对青霉素、苯唑西林及β-内酰胺酶抗生素耐药性达95％以上;革兰阴性杆菌对左氧氟沙星、亚胺培南及美罗培南敏感;真菌以念珠菌为主,对抗真菌药物普遍敏感.结论凝固酶阴性葡萄球菌、肺炎克雷白杆菌、大肠埃希菌等是NICU中新生儿脓毒症最常见的几种病原菌,耐药性高,临床医生应根据细菌鉴定及药敏试验选择敏感药物治疗,且真菌感染不可忽视,值得关注.
목적 연구신생인중증감호실(neonatal intensive care unit,NICU)혈배양양성적농독증환인적병원균분포급내약정황,위림상합리사용항생소제공의거.방법 회고성분석2009년1월지2011년7월엄동의학원부속의원NICU 1450례신생인적1450빈혈배양결과급약민결과.결과 1450빈혈배양표본공분리병원균9충233주,총양성솔위16.1％.기중혁란양성구균93주,이응고매음성포도구균점우세,기차위금황색포도구균;혁란음성간균103주,이폐염극뢰백간균거다,기차위대장애희균、포만불동간균;진균37주,이념주균위주.혁란양성구균대만고매소、리내서알급체고랍저민감성고,대청매소、분서서림급β-내선알매항생소내약성체95％이상;혁란음성간균대좌양불사성、아알배남급미라배남민감;진균이념주균위주,대항진균약물보편민감.결론 응고매음성포도구균、폐염극뢰백간균、대장애희균등시NICU중신생인농독증최상견적궤충병원균,내약성고,림상의생응근거세균감정급약민시험선택민감약물치료,차진균감염불가홀시,치득관주.
Objective To investigate the pathogens distribution and their drug resistance of blood culture-positive neonates with sepsis in neonatal intensive care unit(NICU) and to provide evidence for clinically reasonable use of antibiotics.Methods One thousand four hundred and fifty neonates admitted to our NICU of Affiliated Hospital of Guangdong Medical College from Jan 2009 to Jul 2011 were enrolled.The blood samples from 1 450 neonates were cultured and isolated,and all of the isolates and their resistances were analyzed retrospectively.Results A total of 9 species and 233 pathogenic strains were isolated from 1 450 specimens,and the positive rate was 16.1％.Among the 233 strains,93 strains were gram-positive cocci,103 strains were gram-negative bacilli,and 37 strains were fungus.Among gram-positive cocci,the most dominant organism was coagulase negative staphylococcus,the next was Staphylococcus aureus;while among gram-negative bacilli,Ktebsiella pneumoniae were the most frequently isolated,the next were Escherichia coli and Acinetobacter baumannii,and among the fungus,monilia were the most isolated.The resistance rates of gram-positive cocci to vancomycin,linezolid and teicoplanin were high.Moreover,the antibiotic resistance rates to penicillin,oxazocilline and the β-lactamase were more than 95％.Gram-negative bacilli were sensitive to levofloxacin,imipenem and meropenem.A majority of fungus was Monilia,which was sensitive to antifungal.Conclusion Coagulase negative staphylococcus,Klebsiella pneumoniae and Escherichia coli are the the most common pathogens of neonatal sepsis in NICU,and have high drug resistance.Clinicians should select sensitive drug treatment according to bacterial identification and susceptibility testing.Besides,mycotic infection cannot be ignored and merit our attention.