新生儿重症监护室产ESBLs菌对抗生素的敏感率分析

目的:了解最近5年我院新生儿重症监护室产ESBLs菌对常用抗生素的耐药情况。方法:采用琼脂扩散法检测22株产ESBLs菌对18种抗生素的敏感率。结果:医院感染好发部位为泌尿道、脐部、呼吸道和血液。从297例新生儿病例中分离出317株细菌,其中革兰氏阴性菌166株,包括大肠杆菌80株、假单胞菌23株、肺炎克雷伯氏杆菌20株;产ESBLs菌株共22株,占革兰氏阴性菌13.2%(22/166),其中,产ESBLs大肠埃希氏菌18株(尿7株,脐5株,血液3株,呼吸道2株,皮肤脓液1株),占全部大肠埃希氏菌22.5%,产ESBLs肺炎克雷伯氏菌4株(呼吸道、尿液、皮肤、脐部各1株),占全部肺炎克雷伯氏菌的20%。产ESBLs大肠埃希氏菌和产ESBLs肺炎克雷伯氏菌对氨苄青霉素、哌拉西林、庆大霉素、复方新诺明、头孢唑林、头孢呋辛、头孢噻肟、阿莫西林/克拉维酸、替卡西林/克拉维酸、头孢哌酮、头孢哌酮/舒巴坦、头孢曲松、头孢吡肟高度耐药;对丁胺卡那霉素、哌拉西林/他唑巴坦、头孢他啶、环丙沙星、亚胺培南敏感率仅20%~26%。结论:大肠杆菌是我院新生儿医院感染的主要病原菌之一,肺炎克雷伯氏菌和大肠埃希氏菌产ESBLs的情况已较为严重,产ESBLs菌显示出对多种抗生素的多重耐药性。

Analysis on antimicrobial susceptibility of extended-spectrum β-lacta-mases producing bacteria in neonatal intensive care unit

Objective:To understand the antimicrobial susceptibility of extended-spectrum β-lactamase-producing(ESBLs)bacteria in neonatal intensive care unit(NICU).Methods:22 strains ESBLs bacteria isolated by API/VITEK were identificated.All the susceptibility to 18 antibiotics were tested.Results:Predilection sites of nosocomial infection were urine system,umbilical region,respiratory system,and blood.80 strains Escherichia coli,23 Pseudomonas,20 strains Klebsiella pneumonia were identified from 166 strains of gram-Negative bacilli in all 317 strains bacilli.22 strains ESBLs-producing bacteria isolated from 166 strains of Gram-Negative bacilli consisted of 18 strains Escherichia coli(7 strains from urine,5 umbilical swab,3 blood,2 sputum,1 abscess skin),and 4 strains Klebsiella pneumonia(each one from urine,umbilical swab,abscess skin and sputum).ESBLs-producing accounted of 13.2% gram-negative bacilli.ESBLs-producing Escherichia coli accounted for 22.5% in all Escherichia coli,ESBLs-producing Klebsiella pneumonia accounted for 20% in all Klebsiella pneumonia.The susceptibility of ESBLs-producing bacilli were very low to ampicilline,Piperacilline,Gentamycine,SMZCO,Cefazolin,Zinacef,Amoxillin/clavuier,Ticarcillini/clavulanate,Cefoperazone,cefoperazone/sulbactam,ceftriaxone,cefepime,cefotaxime were very below,only 20%~26% to Piperacilin/ tazobactam,amikacin,Ceftazidime,Ciprofloxacin,Imipenem.Conclusion:Escherichia coli is the most common nosocomial infection in this NICU,Pneumoniae of producing ESBLs in Escherichia coli and Klebsiella bacteria are heavier,and show multi-drug-resistant to antibiotics.