新生儿革兰氏阴性杆菌败血症临床特点及药敏分析

目的分析新生儿革兰氏阴性杆菌败血症的临床特点、病原菌分布及药敏特点,为早期诊断和治疗提供临床依据。方法回顾性分析我院NICU2006年1月～2010年2月确诊的38例革兰氏阴性杆菌败血症临床特点、病原菌分布及耐药情况。结果临床表现的主要特征为发热、吃奶差、皮肤苍白花纹、不哭不动、黄疸、呻吟、呼吸暂停等。37例为单一菌种生长。主要病原菌为肺炎克雷伯杆菌21株（55.26%）,鲍曼不动杆菌6株（15.78%）,大肠埃希氏菌5株（13.15%）。先期使用3代头孢菌素36例、早产儿22例、动脉留置22例、鼻饲喂养21例、外周置入中心静脉导管（Peripherally Inserted Central Catheter,PICC）14例。38例中28例为院内感染,院内感染的病原菌主要是肺炎克雷伯杆菌21例（75%）、鲍曼不动杆菌6例（21.42%）。肺炎克雷伯杆菌17例（80.95%）为产β-内酰胺酶（ESBLS）菌株,对碳青霉烯类、喹诺酮类100%敏感,对哌拉西林/他唑巴坦76.47%敏感,对2、3代头孢类100%耐药。鲍曼不动杆菌对碳青霉烯类及头孢吡肟敏感率33.3%,对青霉素及2、3代头孢类100%耐药。结论新生儿革兰氏阴性杆菌败血症的临床特点是病情凶险,易并发严重并发症,主要病原菌是肺炎克雷伯杆菌、鲍曼不动杆菌及大肠杆菌,而且多为院内感染（73.68%）,与早产、侵入性操作、先期使用3代头孢关系密切,耐药性强,碳青霉烯类是首选药物。

Clinical Features and Drug Sensitivity Analysis of Gram-negative Bacterium Septicemia in the Newborn

Objective To analyze the clinical features,bacterial distribution and drug sensitivity features of gram-negative bacterium septicemia in the newborn in order to provide the evidences for the early diagnosis and treatment of this disease.Methods The clinical features,bacterial distribution and drug resistance of 38 patients confirmed for gram-negative bacterium septicemia in neonatal intensive care unit（NICU） of our hospital from January 2006 to February 2010 were analyzed retrospectively.Results The main characteristics of clinical manifestations were fever,poor feeding,pale mottled skin,non-cry and immobility,jaundice,moaning,apnea,etc.The major pathogens were klebsiella pneumoniae（21 strains,55.26%）,acinetobacter baumannii（6 strains,15.78%） and escherichia coli（5 strains,13.15%）.There were 36 cases with the use of 3-generation cephalosporins,22 cases with premature infants,21 cases with nose feeding,14 cases with central venous catheter（Peripherally Inserted Central Catheter,PICC）.There were 28 cases of nosocomial infection among 38 cases,and the major pathogens of nosocomial infections were klebsiella pneumoniae（21 cases,75%） and acinetobacter baumannii（6 cases,21.42%）.There were 17 strains of klebsiella pneumoniae（80.95%） which produced extended spectrum-lactamase（ESBLs）.It was found that all the klebsiella pneumoniae were sensitive to carbapenem class（imipenem） and fluoroquinolones（the sensitive rate was 100%）,resistant to 2 and 3-generation cephalosporins（the sensitive rate was 0%）,but were sensitive to piperacillin-tazobactam which bound enzyme inhibitor（76.47%）.It was found that all the acinetobacter baumannii stains were resistant to penicillin and 2,3-generation cephalosporin antibiotics（the sensitive rate was 0%）,but were sensitive to carbapenem class and cefepime（the sensitive rate was 33.3%）.Conclusion The clinical features of gram-negative bacterium septicemia are its dreadful disease,and it may predispose the serious complications.The major pathogens are klebsiella pneumoniae,acinetobacter baumannii and escherichia coli,which are almost from nosocomial infections（73.68%）.There are risk factors such as preterm birth,intrusive operation,using 3-generation cephalosporin antibiotic in the newborn,and carbapenems are the first choice.