中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2010年
4期
333-335
,共3页
田鸾英%Aaron Hamvas
田鸞英%Aaron Hamvas
전란영%Aaron Hamvas
新生儿重症监护室%泌尿道感染%病原学%耐药
新生兒重癥鑑護室%泌尿道感染%病原學%耐藥
신생인중증감호실%비뇨도감염%병원학%내약
Neonate intensive care unit%Urinary tract infection%Etiology%Drug resistance
目的 探讨新生儿重症监护室(NICU)中泌尿道感染(UTI)的流行性和病原学特征,为临床合理选用抗生素提供依据.方法 回顾性分析2005年1月至2006年12月间入住圣路易斯华盛顿大学圣路易斯儿童医院NICU的所有新生儿的住院资料.结果 NICU的住院患儿中UTI的发生率为6.5%,最常见的病原菌是革兰阴性菌(63.7%),其中前3位是大肠埃希菌、肺炎克雷白杆菌和阴沟肠杆菌;革兰阳性球菌占24.8%,主要是肠球菌和凝固酶阴性葡萄球菌(CNS).大肠埃希菌、肺炎克雷白杆菌和阴沟肠杆菌对氨苄青霉素均高度耐药,而对庆大霉素和头孢吡肟则高度敏感.革兰阴性菌中非大肠埃希菌菌属的耐药性高于大肠埃希菌.革兰阳性菌中,肠球菌对氨苄青霉素和万古霉素完全敏感;CNS对青霉素、苯唑青霉素和头孢唑啉完全耐药,对万古霉素和利福平则100%敏感.结论 NICU中泌尿系统感染的病原菌以革兰阴性杆菌最常见.青霉素和氨苄青霉素总体耐药现象严重,已不适合作为一线用药.故有必要在使用抗生素前及时完善病原学检测和药物敏感试验以指导临床合理用药.
目的 探討新生兒重癥鑑護室(NICU)中泌尿道感染(UTI)的流行性和病原學特徵,為臨床閤理選用抗生素提供依據.方法 迴顧性分析2005年1月至2006年12月間入住聖路易斯華盛頓大學聖路易斯兒童醫院NICU的所有新生兒的住院資料.結果 NICU的住院患兒中UTI的髮生率為6.5%,最常見的病原菌是革蘭陰性菌(63.7%),其中前3位是大腸埃希菌、肺炎剋雷白桿菌和陰溝腸桿菌;革蘭暘性毬菌佔24.8%,主要是腸毬菌和凝固酶陰性葡萄毬菌(CNS).大腸埃希菌、肺炎剋雷白桿菌和陰溝腸桿菌對氨芐青黴素均高度耐藥,而對慶大黴素和頭孢吡肟則高度敏感.革蘭陰性菌中非大腸埃希菌菌屬的耐藥性高于大腸埃希菌.革蘭暘性菌中,腸毬菌對氨芐青黴素和萬古黴素完全敏感;CNS對青黴素、苯唑青黴素和頭孢唑啉完全耐藥,對萬古黴素和利福平則100%敏感.結論 NICU中泌尿繫統感染的病原菌以革蘭陰性桿菌最常見.青黴素和氨芐青黴素總體耐藥現象嚴重,已不適閤作為一線用藥.故有必要在使用抗生素前及時完善病原學檢測和藥物敏感試驗以指導臨床閤理用藥.
목적 탐토신생인중증감호실(NICU)중비뇨도감염(UTI)적류행성화병원학특정,위림상합리선용항생소제공의거.방법 회고성분석2005년1월지2006년12월간입주골로역사화성돈대학골로역사인동의원NICU적소유신생인적주원자료.결과 NICU적주원환인중UTI적발생솔위6.5%,최상견적병원균시혁란음성균(63.7%),기중전3위시대장애희균、폐염극뢰백간균화음구장간균;혁란양성구균점24.8%,주요시장구균화응고매음성포도구균(CNS).대장애희균、폐염극뢰백간균화음구장간균대안변청매소균고도내약,이대경대매소화두포필우칙고도민감.혁란음성균중비대장애희균균속적내약성고우대장애희균.혁란양성균중,장구균대안변청매소화만고매소완전민감;CNS대청매소、분서청매소화두포서람완전내약,대만고매소화리복평칙100%민감.결론 NICU중비뇨계통감염적병원균이혁란음성간균최상견.청매소화안변청매소총체내약현상엄중,이불괄합작위일선용약.고유필요재사용항생소전급시완선병원학검측화약물민감시험이지도림상합리용약.
Objective To study the constituent ratio and antimicrobial susceptibility patterns of pathogenic bacteria in patients with urinary tract infection (UTI) in NICU. Methods Data were collected retrospectively of neonates who admitted to NICU in St. Louis Children' s Hospital in Washington University School of Medicine between Jan 1 ,2005 and Dec 31,2006. Results The prevalence of UTI in NICU was 6. 5%. Gram-negative organisms were the most common agents of UTI in NICU,of which Ecoli ranked highest ,followed by Klebiella and Enterobacter cloacae. Of gram-positive organisms Enterococcus species and Coagulase-negative Staphylococci were the most common agents. Cefepime and gentamycin showed high activity against gram-negative organisms. Overall, non-E. coli microorganisms showed more resistances compared with Escherichia coli. The best susceptible antibiotics for gram-positive organisms were vancomycin and rifampin. Almost all gram-negative bacteria showed resistant to ampicillin and all of gram-positive bacteria resistant to penicillin and oxacillin. Conclusion Gram-negative organisms were the most common agents of UTI in NICU in this study. The drug resistance of bacteria is severe,especially to ampicillin and penicillin,which will be no longer the first choice clinically. So urine culture should be examined when initiating antibiotics treatment for UTI.
