８１ 例新生儿败血症病原分布及耐药性分析

目的：分析新生儿败血症病原学特点及致病菌耐药情况。方法回顾性分析81例新生儿败血症血培养及药敏试验结果。结果共检出病原菌81株，其中革兰阳性菌42株（51．85％），革兰阴性菌34株（41．98％），真菌5株（6．17％）。革兰阳性菌中检出耐甲氧西林凝固酶阴性葡萄球菌25株（59．52％），革兰阴性菌中检出产超广谱β内酰胺酶（产 ESBLs ）菌12株（35．29％）。排在前5位的细菌为表皮葡萄球菌、肺炎克雷伯菌、大肠埃希菌、产气肠杆菌及阴沟肠杆菌。革兰阳性菌对青霉素100％耐药，对红霉素、复方新诺明、克林霉素耐药率高（52．00％～100．00％），对万古霉素、利奈唑胺尚无耐药。革兰阴性菌对氧哌嗪青霉素、头孢呋辛、头孢噻肟、头孢曲松、头孢他啶均有较高耐药率（42．86％～100．00％），其中产ESBLs菌对上述几种药物及头孢吡肟100％耐药，对含酶抑制剂的抗菌药物耐药率相对较低（0％～33．33％），未发现对亚胺培南、美罗培南耐药菌株。真菌中白色念珠菌最多见，未发现对氟康唑、伊曲康唑、伏立康唑及两性霉素B耐药菌株。结论根据血培养及药敏试验结果选择治疗用药更合理、有效，并可减少耐药菌株产生。

Analysis of bacterial distribution and drug resistance in 81 cases of neonatal sepsis

Objective To investigate the distribution and antibiotic resistance of isolated pathogens in neonatal sepsis. Methods The results of blood culture and drug susceptibility test in neonates sepsis from January 2012 to September 2014 were retrospectively analyzed. Results Eighty one strains were detected in the blood samples,with 42 (51. 85%)Gram-positive bacteria,34 (41. 98%)Gram-negative bacteria and 5(6. 17%)fungus. Staphylococcus epidermidis,Klebsiella pneumonia,Escherichia coli,Enterobacter aerogenes,and Enter-obacter cloacae were the five most common pathogens. Gram-positive cocci was strongly resistant to pencillin(100. 00%),erythromyci,cotri-moxazole,clindamycin(52. 00% ~100. 00%),but still sensitive to vancomycin and linezolid. Gram-negative bacteria was strongly resistant to piperacillin,cefuroxime,cefotaxime,Ceftriaxone,and ceftazidime(42. 86% ~100. 00%). The resistance rate of extended-spectrum beta-lactamase producing bacteria to piperacillin,cefuroxime,cefotaxime,Ceftriaxone,ceftazidime and cefepime was 100. 00%,but low tocompound containing beta-lactamase inhibitors (such as Amoxicillin/acid, Piperacillin/Tazobactam and ticarcillin/acid ) (0. 00% ~33. 33%). The resistance rate of bacteria to imipenem and meropenem was 0. 00%. Conclusion The selection of sensitive antibiotics based on pathogens and drug resistance testing for the treatment of neonatal sepsis is more reasonable and more effective,which can reduce the gen-eration of drug-resistant strains.