CAJ | 학술논문

目的：探讨新生儿败血症的病原菌分布特点及耐药特征，以指导临床治疗。方法：收集笔者所在医院2010年1月-2013年4月新生儿科及新生儿重症监护室确诊为新生儿败血症患儿177例的临床资料，对其血培养结果及药敏情况进行回顾性分析。结果：177例患儿血培养标本中共检出病原菌184株(同一份血培养中检出两种病原菌的患儿有7例)，革兰阳性菌110株(59.8%)，其中表皮葡萄球菌44株(23.9%)、溶血葡萄球菌15株(8.2%)、人葡萄球菌12株(6.5%)，革兰阳性菌中以凝固酶阴性葡萄球菌为主，占所有检出菌株的46.7%；革兰阴性菌56株(30.4%)，以肺炎克雷伯菌为主，22株(12.0%)，其次为大肠埃希菌19株(10.3%)；真菌18株(9.8%)，以白色假丝酵母菌为主，11株(6.0%)。革兰阳性菌对青霉素G、氨苄西林、林可霉素及大环内酯类普遍耐药，对哌拉西林他唑巴坦、及喹诺酮类抗生素敏感性高，未发现万古霉素耐药菌株，革兰阴性菌对氨苄西林及头孢菌素类抗生素普遍耐药，对阿米卡星、喹诺酮类及碳青霉烯类抗生素有较高的敏感性；真菌对康唑类药物普遍敏感。结论：凝固酶阴性葡萄球菌是新生儿败血症最常见的致病菌，其次为肺炎克雷伯菌及大肠埃希菌，均对常见抗生素耐药率高；白色假丝酵母菌是真菌败血症的主要致病菌，对康唑类药物普遍敏感，应掌握新生儿败血症病原菌分布及耐药情况，根据其药敏结果使用抗菌药物。
목적：탐토신생인패혈증적병원균분포특점급내약특정，이지도림상치료。방법：수집필자소재의원2010년1월-2013년4월신생인과급신생인중증감호실학진위신생인패혈증환인177례적림상자료，대기혈배양결과급약민정황진행회고성분석。결과：177례환인혈배양표본중공검출병원균184주(동일빈혈배양중검출량충병원균적환인유7례)，혁란양성균110주(59.8%)，기중표피포도구균44주(23.9%)、용혈포도구균15주(8.2%)、인포도구균12주(6.5%)，혁란양성균중이응고매음성포도구균위주，점소유검출균주적46.7%；혁란음성균56주(30.4%)，이폐염극뢰백균위주，22주(12.0%)，기차위대장애희균19주(10.3%)；진균18주(9.8%)，이백색가사효모균위주，11주(6.0%)。혁란양성균대청매소G、안변서림、림가매소급대배내지류보편내약，대고랍서림타서파탄、급규낙동류항생소민감성고，미발현만고매소내약균주，혁란음성균대안변서림급두포균소류항생소보편내약，대아미잡성、규낙동류급탄청매희류항생소유교고적민감성；진균대강서류약물보편민감。결론：응고매음성포도구균시신생인패혈증최상견적치병균，기차위폐염극뢰백균급대장애희균，균대상견항생소내약솔고；백색가사효모균시진균패혈증적주요치병균，대강서류약물보편민감，응장악신생인패혈증병원균분포급내약정황，근거기약민결과사용항균약물。
Objective:To investigate distribution characteristics and antibiotic resistance of pathogens in septicemia of the newborn,and to guide the clinical treatment.Method:The clinical data of 177 neonates who were received in the neonatology ward or the neonate intensive care unit (NICU) and diagnosed with septicemia from January 2010 to April 2013 were collected,and the results of blood culture and antimicrobial susceptibility were reviewed retrospectively. Result:A total of 184 strains were detected from 177 blood specimens(7 patients were isolated two kinds of pathogens in one specimen),of which 110(59.8%) strains were Gram-positive bacteria,and 56(30.4%) strains were Gram-negative bacteria,and 18(9.8%) strains were fungi.Gram-positive bacteria were mainly consisted of Staphylococcus epidermidis(23.9%),Staphylococcus haemolyticus(8.2%) and staphylococcus haemolyticus(6.5%),while the Coagulase-negative Staphylococcus accounted for 46.7%of the total separated strains.Klebsiella pneumoniae and Escherichia coli were the dominant strains in the Gram-negative bacterias,accounted for 12.0%and 10.3%of the total isolated strains respectively.Candida albicans was the major strain of fungi,amounted to 6%of total detected strains. Gram-positive bacteria demonstrated a strong resistance to Penicillin G,ampicillin,macrolides and lincomycin,while they was sensitive to Piperacillin/tazobactam,quinolones,and Vancomycin-resistant strain was not found.The Gram-negative bacteria were resistant to Ampicillin and cephalosporins,but their susceptibility to Amikacin ,quinolones and carbapenems was obvious.Fungi had a high sensitivity to Itraconazole antibiotics.Conclusion:Coagulase-negative staphylococci is the most common pathogens causing neonatal sepsis in the latest three years in our hospital,followed by Klebsiella pneumoniae and Escherichia coli.They have resistance to common antibiotics.Candida albicans is the main pathogen of Fungal sepsis,has a high sensitivity to Itraconazole antibiotics.It is suggested that antibiotics should be used under the guidance of antibiotic susceptibility testing.