新生儿败血症病原菌及药物敏感性

目的 分析新生儿败血症血培养病原菌的构成和药物敏感性,指导临床合理应用抗生素.方法 对108例新生儿败血症血培养阳性进行分析,用法国梅里埃VITEK-32全自动微生物测试仪进行细菌培养鉴定和药敏试验.结果 在435例可疑标本中,分离和鉴定出108株细菌,阳性率为24.8%,其中检出革兰阳性(G )菌为69.4%,凝固酶阴性葡萄球菌(CNS)为主要病原菌,其中表皮葡萄球菌为首位(26株,占24.1%);革兰阴性(G-)菌为30.6%,以大肠埃希菌为主(15株,占13.9%).G 菌前3种细菌对青霉素、苯唑西林、氨苄西林/舒巴坦、红霉素和头孢唑啉敏感率是0%～30.7%,对万古霉素、力奈唑烷和呋喃妥因高度敏感;G-菌前3种细菌对氨苄西林、氨苄西林/舒巴坦、复方新诺明和头孢唑啉敏感率是0%～40%,对亚胺培南和丁胺卡那霉素敏感率大于80%.57.4%为早期发作的败血症病例,42.6%为晚期发作的病例.结论 引起新生儿败血症的细菌以革兰阳性球菌为主,CNS为主要病原菌,临床应根据血培养药敏结果选用敏感抗生素,以减少细菌耐药性的产生,提高治疗效果.

Analysis of pathogens and drug sensitivity test in neonatal septicemia

Objective To study the pathogens and drug sensitivity test in neonatal septicemia in order to instruct proper use of antibiotics.Methods The clinical data of 108 cases of neonatal septicemia were analyzed restrospectively. Bacteria were identified and susceptibility test was performed using the VITEK-32 Auto-Microbic System.Results Of 435 blood samples, 108 (24.8%) were positive for bacterial isolates. Gram-positive cocci (69.4%) predominated over Gram-negative bacilli (30.6%), Coagulase negative staphylococcus was main pathogens, among which 24.1% was S.epidermidis, 13.9% Escherichia coli were main pathogens of Gram-negative bacilli. The Gram-positive cocci were sensitive(0%-30%) to penicillin-G, oxacillin, ampicillin/sulbactam, erythromycin and cefazolin. Vancomycin, linezolid, and nitrofurantoin were the most sensitive drugs. The Gram-negative bacill were sensitive (0%-40%) to ampicillin, ampicillin/sulbactam, trimethoprim/sulfa and cefazolin. Imipenem and amikacin were the most sensitive drugs. 57.4% of cases was stricken by septicemia onset in early phase, and morbility onset in late phase was 42.6%.Conclusion Gram-positive cocci is main pathogens in neonatal septicemia, as coagulase negative staphylococcus the most. To choose sensitive antibiotics base on the drug sensitivity tests may decrease the occurrence of drug resistant to bacteria and increase the clinical curative effects.