四川医学
四川醫學
사천의학
Sichuan Medical Journal
2015年
8期
1073-1077
,共5页
赵静%张鸽%杨晓燕%唐军%石晶
趙靜%張鴿%楊曉燕%唐軍%石晶
조정%장합%양효연%당군%석정
新生儿%败血症%病原菌%耐药性
新生兒%敗血癥%病原菌%耐藥性
신생인%패혈증%병원균%내약성
neonates%sepsis%pathogen%drug resistance
目的 了解我院近5年新生儿败血症病原菌构成、分布情况及耐药特点,为临床治疗提供指导. 方法 收集2009年1月1日至2015年4月30日在我科住院确诊为新生儿败血症患儿血培养检出细菌情况及药敏试验结果,分析病原菌分布和耐药情况. 结果 5年确诊新生儿败血症并分离血培养阳性菌共182株,大肠埃希菌43株( 23. 63%)、肺炎克雷伯菌37株( 20. 33%)、凝固酶阴性葡萄球菌31 株( 17. 03%)、念珠菌16 株( 8. 79%)及金黄色葡萄球菌15 株(8. 24%)是导致新生败血症的主要致病菌. 早发型败血症主要病原菌为大肠埃希菌、肺炎克雷伯菌及凝固酶阴性葡萄球,晚发型败血症主要致病菌为肺炎克雷伯菌、凝固酶阴性葡萄球及念珠菌. 革兰阴性菌对氨苄西林耐药率在95%以上,晚发型革兰阴性菌败血症主要以超广谱β-内酰胺酶( Extended-Spectrum β-Lactamases,ESBL)阳性菌为主,对碳青霉烯类抗生素、头孢替坦及阿米卡星尚未发现耐药,对头孢唑林和头孢曲松耐药率在60%以上. 葡萄球菌对青霉素耐药率在80%以上,对糖肽类抗生素尚未发现耐药. 念珠菌对三唑类抗真菌药耐药率在40%左右,对两性霉素B及5-氟胞嘧啶尚未发现耐药. 结论 本院近5年新生儿败血症致病菌主要为大肠埃希菌、肺炎克雷伯菌及凝固酶阴性葡萄球菌,早发型败血症和晚发型败血症致病菌构成及细菌耐药谱具有差异,定期监测新生儿败血症致病菌及耐药性有助于临床合理使用抗生素治疗.
目的 瞭解我院近5年新生兒敗血癥病原菌構成、分佈情況及耐藥特點,為臨床治療提供指導. 方法 收集2009年1月1日至2015年4月30日在我科住院確診為新生兒敗血癥患兒血培養檢齣細菌情況及藥敏試驗結果,分析病原菌分佈和耐藥情況. 結果 5年確診新生兒敗血癥併分離血培養暘性菌共182株,大腸埃希菌43株( 23. 63%)、肺炎剋雷伯菌37株( 20. 33%)、凝固酶陰性葡萄毬菌31 株( 17. 03%)、唸珠菌16 株( 8. 79%)及金黃色葡萄毬菌15 株(8. 24%)是導緻新生敗血癥的主要緻病菌. 早髮型敗血癥主要病原菌為大腸埃希菌、肺炎剋雷伯菌及凝固酶陰性葡萄毬,晚髮型敗血癥主要緻病菌為肺炎剋雷伯菌、凝固酶陰性葡萄毬及唸珠菌. 革蘭陰性菌對氨芐西林耐藥率在95%以上,晚髮型革蘭陰性菌敗血癥主要以超廣譜β-內酰胺酶( Extended-Spectrum β-Lactamases,ESBL)暘性菌為主,對碳青黴烯類抗生素、頭孢替坦及阿米卡星尚未髮現耐藥,對頭孢唑林和頭孢麯鬆耐藥率在60%以上. 葡萄毬菌對青黴素耐藥率在80%以上,對糖肽類抗生素尚未髮現耐藥. 唸珠菌對三唑類抗真菌藥耐藥率在40%左右,對兩性黴素B及5-氟胞嘧啶尚未髮現耐藥. 結論 本院近5年新生兒敗血癥緻病菌主要為大腸埃希菌、肺炎剋雷伯菌及凝固酶陰性葡萄毬菌,早髮型敗血癥和晚髮型敗血癥緻病菌構成及細菌耐藥譜具有差異,定期鑑測新生兒敗血癥緻病菌及耐藥性有助于臨床閤理使用抗生素治療.
목적 료해아원근5년신생인패혈증병원균구성、분포정황급내약특점,위림상치료제공지도. 방법 수집2009년1월1일지2015년4월30일재아과주원학진위신생인패혈증환인혈배양검출세균정황급약민시험결과,분석병원균분포화내약정황. 결과 5년학진신생인패혈증병분리혈배양양성균공182주,대장애희균43주( 23. 63%)、폐염극뢰백균37주( 20. 33%)、응고매음성포도구균31 주( 17. 03%)、념주균16 주( 8. 79%)급금황색포도구균15 주(8. 24%)시도치신생패혈증적주요치병균. 조발형패혈증주요병원균위대장애희균、폐염극뢰백균급응고매음성포도구,만발형패혈증주요치병균위폐염극뢰백균、응고매음성포도구급념주균. 혁란음성균대안변서림내약솔재95%이상,만발형혁란음성균패혈증주요이초엄보β-내선알매( Extended-Spectrum β-Lactamases,ESBL)양성균위주,대탄청매희류항생소、두포체탄급아미잡성상미발현내약,대두포서림화두포곡송내약솔재60%이상. 포도구균대청매소내약솔재80%이상,대당태류항생소상미발현내약. 념주균대삼서류항진균약내약솔재40%좌우,대량성매소B급5-불포밀정상미발현내약. 결론 본원근5년신생인패혈증치병균주요위대장애희균、폐염극뢰백균급응고매음성포도구균,조발형패혈증화만발형패혈증치병균구성급세균내약보구유차이,정기감측신생인패혈증치병균급내약성유조우림상합리사용항생소치료.
Objective To investigat the composition, distribution and drug resistance characteristics of the pathogens iso-lated from newborns with sepsis in our hospital in recent 5 years so as to provide evidence for clinical treatment. Methods A ret-rospective study of neonatal sepsis was conducted in West China Second University Hospital from January 1, 2008 to April 30, 2015. The results of pathogen and drug resistance were anylized. Results 182 stains were detected in recent five years. Esche-richia coli ( 43/182, 23. 63%), Klebsiella pneumoniae ( 37/182, 20. 33%), Coagulase-Negative staphylococci ( 31/182, 17. 03%), fungi (16/182,8. 79%)and Staphylococcus aureus(15/182,8. 24%) were the five most common pathogens. Esche-richia coli, Klebsiella pneumoniae and Coagulase-Negative staphylococci were the main pathogens causing early-onset of sepsis, while Klebsiella pneumoniae, Coagulase-Negative staphylococci and fungi were the main pathogens for late-onset sepsis. The drug resistance of Gram-negative bacilli to ampicillin was above 95%. Extended-Spectrumβ-Lactamases positive bacteria were the main pathogens of late-onset sepsis, and they demonstrated a strong resistance to Cefazolin and ceftazidime ( above 60%) . They didn't show any resistance to imipenem, cefotan and amikacin. The drug resistance of Staphylococcus to penicillin were more than 80%. We didn't found any Gram-positve bacteria resistant to vancomycin. The fungi demonstrated about 40% resistance to triazole anti-fungal drugs. No fungi were resistance to amphotericin B and 5-fluorocytosine. Conclusion Escherichia coli, pneumonia Kleb-siella and coagulase negative staphylococci were the main pathogens causing neonatal sespis in rencent 5 years in our hospital. Pathogens and bacteria drug resistance were difference in Early-onset and late-onset sepsis. Regular monitoring of pathogens and drug resistance could be helpful for clinical rational use of antibiotics in neonatal sepsis.
