新生儿大肠埃希菌败血症三例

2000年3月20日～23日,我院收治3例大肠埃希菌感染的新生儿,现报告如下。     

住院新生儿感染大肠埃希菌耐药性分析

目的分析住院新生儿临床标本中分离的大肠埃希菌对抗菌药物的耐药性状况,寻找新生儿病房大肠埃希菌耐药基因来源,为临床合理用药提供依据。方法收集2009年9月至2011年11月本院住院新生儿的临床标本,将从中分离的大肠埃希菌作为研究对象,采用纸片扩散法(K-B法)检测大肠埃希菌对8种抗生素的耐药性。结果共分离出100株大肠埃希菌,这些菌株对8种抗菌药物的耐药率从高到低依次为头孢噻肟(67%)、四环素(58%)、左氧氟沙星(34%)、头孢吡肟(33%)、头孢西丁(26%)、氯霉素(19%)、阿米卡星(13%),未发现对美罗培南耐药的菌株。100株大肠埃希菌超广谱β-内酰胺酶(ESBLs)检出率为55%,痰液大肠埃希菌菌株ESBL检出率为65%,明显高于无菌体液(血液、脑脊液)的27%。产ESBL大肠埃希菌菌株对头孢噻肟、头孢吡肟的耐药率明显高于非产ESBL大肠埃希菌菌株。大肠埃希菌多重耐药率为15%,耐药谱型以β-内酰胺类、氨基糖苷类、喹诺酮类、氯霉素类、四环素为主,占8%。结论住院新生儿临床送检标本中,大肠埃希菌对头孢类抗生素耐药情况严重,对大肠埃希菌的耐药率及耐药模式进行连续监测,对于临床用药有重要价值。     

新生儿大肠埃希菌化脓性脑膜炎临床特点及耐药性分析

目的了解新生儿大肠埃希菌化脓性脑膜炎的临床特点及耐药性情况。方法回顾性分析2004年6月—2014年6月收治的46例新生儿大肠埃希菌化脓性脑膜炎的临床资料,46例新生儿分为社区感染组和院内感染组,以及2004年6月—2009年5月的早期组和2009年6月—2014年6月的晚期组,分别比较临床表现及产超广谱β内酰胺酶(ESBLs)检出率和药敏试验结果。结果患儿均以发热或体温不升,反应差,少吃或拒乳,呼吸、心率增快为临床表现。院内感染组ESBLs检出率明显高于社区感染组,晚期组ESBLs检出率明显高于早期组,差异均有统计学意义(P??0.05)。院内感染组对常用的头孢菌素类抗生素耐药性明显高于社区感染组,晚期组对常用的青霉素类、头孢菌素类抗生素耐药性明显高于早期组,差异均有统计学意义(P??0.05)。结论新生儿大肠埃希菌化脓性脑膜炎临床表现不典型,近年来大肠埃希菌对青霉素类及头孢菌素类抗生药物的耐药性显著上升,院内感染是获得ESBLs的高危因素。     

新生儿社区获得性大肠埃希菌败血症13例临床分析

大肠埃希菌是社区和医院获得性感染常见的致病菌 ,新生儿大肠埃希菌败血症合并症多 ,病死率高 ,但临床报告者少。现将我院自 1996年 1月—2 0 0 1年 6月收治的经血培养证实的 13例新生儿大肠埃希菌败血症分析报告如下。1　临床资料13例中男 5例 ,女 8例。 8～14ｄ 12例 ,～ 2 1     

大肠埃希菌所致新生儿败血症的特征分析

<正>新生儿败血症指新生儿期细菌侵入血液循环,并在其中繁殖和产生毒素所造成的全身性感染,有时还在体内产生迁移病灶。新生儿败血症是新生儿期较常见疾病,严重威胁新生儿健康。大肠埃希菌是最常见的导致新生儿败血症的革兰阴性病原菌,耐药的大肠埃希菌引起新生儿感染已逐渐增多,成为亟待解决的问题。     

新生儿社区获得性大肠埃希菌败血症13例

为探讨新生儿社区获得性大肠埃希菌败血症的临床特点与药物选择。研究对象为 13例经 2次血培养证实为大肠埃希菌败血症的新生儿 ,对其临床特点及药敏试验结果进行回顾性分析。结果治愈 2例 ,好转 4例 ,自动出院 3例 ,死亡6例 ,均有严重合并症。社区获得性大肠埃希菌感染对多数头孢菌素、氨基糖甙类、碳青霉烯类 ,β内酰胺类抗生素 / β内酰胺酶抑制剂敏感。故认为治疗新生儿社区获得性大肠埃希菌败血症首选菌必治或头孢噻肟 ,也可选用 β内酰胺类抗生素 / β内酰胺酶抑制剂、碳青霉烯类等。新生儿社区获得性大肠埃希菌败血症13例$福建省泉州市儿童医院!362000@曾建军 $福建省泉州市第一医院产科!362000@李萍     

新生儿败血症病原菌十年变迁及耐药性分析

目的 了解本院近10年来新生儿败血症病原菌及其耐药性变迁,以指导临床用药.方法 对1997年3月至2002年3月收治的新生儿败血症(第1组)血培养检出茵、药敏试验结果进行回顾性调查,并与2002年4月至2007年3月的调查结果(第2组)进行比较.结果 10年来新生儿败血症血培养阳性的患儿296例,第1组155例,第2组141例,病原菌以革兰阳性细菌为主,近5年来凝固酶阴性葡萄球菌(CNS)感染率明显增加(x2=14.15,P＜0.01),金葡茵感染率显著下降(x2=10.88,P＜0.01),对青霉素、苯唑西林及红霉素有较高的耐药率,多重耐药较明显,耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)及耐甲氧西林的金葡菌(MRSA)感染增多,对万古霉素敏感性较高.革兰阴性杆菌对氨苄西林普遍耐药,对亚胺培南、氨曲南高度敏感,对氨基糖甙类、喹诺酮类及三代头孢菌素敏感性较高,但耐药菌株有增加的趋势.结论 CNS是本院新生儿败血症最主要的病原菌,对青霉素等常用抗生素普遍耐药,多重耐药菌株增加,根据病原茵药敏结果合理使用抗生素.是有效抗感染和延缓耐药菌株产生的必要条件.     

婴儿大肠埃希菌肺炎临床特点及耐药性分析

目的了解婴儿大肠埃希菌肺炎的临床特征、超广谱β内酰胺酶(ESBLs)检出率及大肠埃希菌耐药性。方法将2003年6月—2013年6月336例婴儿大肠埃希菌肺炎分为社区感染组和院内感染组,分析临床资料,统计ESBLs检出率和药敏试验结果。结果患儿发病年龄以1~6个月为主,临床特征与其他革兰阴性杆菌肺炎相似。分离的336株大肠埃希菌中196株(58.33%)产ESBLs,院内感染组ESBLs阳性率为84.00%,高于社区感染组的50.96%,差异有统计学意义(χ2=26.17,P0.05)。2003年6月—2008年5月与2008年6月—2013年6月两个时间段比较,社区感染组的ESBLs阳性率为49.21%和52.59%,差异无统计学意义(χ2=0.30,P0.05);而院内感染组从76.74%升高至93.75%,差异有统计学意义(χ2=3.95,P0.05)。药敏试验结果显示,最敏感的抗生素为碳青霉烯类。结论大肠埃希菌肺炎好发于小婴儿,病情重且容易迁延,院内感染是获得ESBLs的高危因素。社区感染及院内感染抗生素的应用应该有所区别。     

北京儿童医院出培养检出菌17年的变迁及耐药性探讨

目的 探讨随年价变迁北京儿童医院血培养检出菌构成比的变化规律,以及与患儿年龄、季节等关系,并观察近年菌株耐药性。方法 归纳我院1983～1999年间血培养检出菌6569株。1997年采用葡萄糖肉汤,API系统及手工鉴定,1997年后用BD血培养仪培养。用API系统和microscan半自动微生物分析仪鉴定细菌种类,用microscan检测药敏,以美国临床实验室标准化委员会（NCCLS）判断结果。结果 凝固酶阴性葡萄球菌（CNS）检出构成比历年居于50%以上。肠球菌由本世纪90年代初4.8%上升到1999年15.7%（屎肠球菌占总数68.8%）,克雷伯菌属由0.4%升到1999年3.1%。肠杆菌属由0.1%升为1.4%。而大肠艾希菌及金黄色葡萄球菌分别由1983年的8.1%、6.3%降为近年的2.1%、1.6%。沙门菌由2.7%降为0.2%。葡萄球菌产酶率92%～100%,耐甲氧西林金葡（MRSA）占16%,耐甲氧西林CNS（MRCNS）占64.1%。屎肠球菌、粪肠球菌对氨苄西林、青霉素耐药率分别为83%、86%和18%、33%,HLAR为60%、40%,VRE为4%、10%。肠杆菌科菌对亚胺培南、头孢他定、丁胺卡那、氨曲南耐药率50%以下。大肠艾希菌、克雷伯菌中产超广谱β-内酰胺酶菌株（ESBL）分别为64.2%和88%。结论 （1）低毒力条件致病菌成为当前儿科常见致病菌。（2）小婴儿的革兰阳性（G ）菌CNS尿肠球菌、复数菌检出构成比高于其他年龄。（3）小儿检出菌的种类及耐药率高于成人。治疗需以药物监测为依据。     

Incidence of kanamycin resistance among Escherichia coli isolates from neonates

The antimicrobial susceptibilities of 368 E. coli strains isolated from well neonates, well pediatric outpatients, and ill neonates were determined, and the incidence of antibiotic-resistant strains was correlated with epidemiologic data. Ninety-five per cent of these isolates were susceptible to kanamycin and 98 per cent to gentamicin. Most of the difference in susceptibility of these E. coli strains to kanamycin and gentamicin appeared to be on the basis of weight for weight activity. Kanamycin-susceptible strains were isolated from 96 per cent of well neonates and well outpatients, and 94 per cent of ill neonates, age three days or less. An increase in the incidence of resistance to kanamycin, streptomycin, and ampicillin among strains isolated from neonates was related to prolonged hospitalization and/or prior antibiotic therapy. This study demonstrates the need for analyzing antimicrobial susceptibility data from newborn nurseries in an epidemiologic context.     

Hemostatic changes in neonates with anoxia and sepsis

Hemostatic profile (prothrombin time (PT), thrombin time (TT), kaolin cephalin clotting time (KCCT), plasma fibrinogen, serum fibrin/fibrinogen degradation products (FDP) and platelet counts) was examined in 153 neonates with birth anoxia and 86 with sepsis. Remarkable hemostatic alterations occurred in neonates with severe anoxia and sepsis, while those with moderate anoxia exhibited minimal or no change. Vitamin K administration to anoxic babies showed no improvement in the hemostatic profile after 48-72 hours. The hemostatic alterations were presumably due to incipient disseminated intravascular coagulation (DIC). In spite of the marked coagulation changes, only 3 neonates with sepsis and none of the anoxic newborns presented with clinical bleeding indicating a well balanced hemostatic mechanism.     

Nontyphoid salmonellosis in taiwan children: clinical manifestations, outcome and antibiotic resistance

OBJECTIVES: The purposes of this study were to investigate the epidemiologic, clinical, and microbiologic features of patients with nontyphoid salmonellosis and to elucidate the impact of resistance on the outcome of nontyphoid salmonellosis in Taiwan. The authors also sought to develop a severity score to derive an objective guideline for antibiotic use in nontyphoid salmonellosis in the era of increasing antibiotic resistance. METHODS: The authors prospectively monitored 311 children with nontyphoid salmonellosis in Kaohsiung, Taiwan. The demographic, clinical, and microbiologic features, underlying diseases, treatment regimen, complications, and outcome were analyzed. In vitro susceptibility testing of the isolates was performed. RESULTS: The median age of affected patients was 15 months. Salmonella enteritidis B caused 68.5% of episodes, followed by S. enteritidis C1 (11.9%), D (7.7%), C2 (7.1%), E (2.6%), S. choleraesuis (1.6%), and S. paratyphi (0.6%). Sixty percent of isolates were resistant to ampicillin. Patients with bacteremia could not be differentiated from patients without bacteremia on clinical grounds. Patients receiving antibiotics that were inactive in vitro (discordant therapy) had more days of fever and longer hospital stay compared with patients receiving antibiotics that were active in vitro (concordant therapy). Patients receiving no antibiotic treatment had the fewest days of fever and shortest hospital stays, especially among patients with mild illness (severity score, 0-1). CONCLUSION: Blood culture should be obtained in patients with nontyphoid salmonellosis to detect bacteremia. In treating antibiotic-resistant nontyphoid salmonellosis, antibiotics are still not mandatory for patients who present with primarily gastrointestinal symptoms and limited signs of systemic inflammation reflected by a low severity score (low C-reactive protein, fewer band cells in peripheral blood, and fewer days of fever before admission). Susceptibility data should be promptly obtained because use of discordant antibiotics appears to prolong illness.     

1 606例新生儿败血症病原菌分布及其耐药性分析

目的研究败血症新生儿的病原菌分布及其耐药情况。方法回顾性分析2002年至2012年间收入新生儿重症监护病房的新生儿血培养及其药敏分析结果。结果共28 120份新生儿血培养标本中培养阳性1 606份(5.7%),共培养出病原菌1 665株;其中革兰阳性菌1 336株,以表皮葡萄球菌(902株)及溶血性葡萄球菌(206株)为主;革兰阴性菌235株,以肺炎克雷伯杆菌(108株)及大肠埃希菌(73株)为主。逐年比较,不同菌株的检出率差异有统计学意义(P0.05)。2012年175株病原菌的药敏结果显示,革兰阳性菌对利奈唑胺、替加环素和万古霉素的敏感率高,对青霉素耐药性达90%以上;革兰阴性菌对阿米卡星及亚胺培南敏感性高,对氨苄西林的耐药性较高。结论表皮葡萄球菌、溶血性葡萄球菌、肺炎克雷伯杆菌及大肠埃希菌是新生儿败血症的主要病原菌,且普遍对青霉素耐药。     

Coagulase-negative staphylococcal sepsis in neonates. Association between antibiotic resistance, biofilm formation and the host inflammatory response

BACKGROUND: Coagulase-negative staphylococci (CoNS) are the most prevalent pathogens causing late onset sepsis in neonates. They are often multiresistant to antibiotics, and the ability to form biofilm is considered their main virulence determinant. METHODS: During a 12-year period, we identified 150 neonates having 164 suspected septic episodes with growth of CoNS in blood culture. We examined the relationship between antibiotic resistance, phenotypic biofilm production and genetic determinants for biofilm formation in different CoNS species and their correlation with neonatal inflammatory response. RESULTS: Eighty-five episodes were classified as true sepsis, and 79 episodes of CoNS growth in blood culture were considered contaminations. Sixty-one percent of Staphylococcus epidermidis isolates produced biofilm compared with 26% of CoNS non-epidermidis (P < 0.001). We observed no difference in phenotypic biofilm production or genetic determinants for biofilm formation between invasive isolates and contaminants. C-reactive protein levels as a marker of inflammatory response were higher in CoNS sepsis caused by methicillin and aminoglycoside resistant versus susceptible isolates (P = 0.031). In contrast, there was a significant association between a lower C-reactive protein response and biofilm-positive isolates (P = 0.018). Antibiotic resistance was significantly correlated with biofilm production in S. epidermidis, but not in other CoNS species. CONCLUSIONS: CoNS sepsis with biofilm-forming strains was associated with a decreased host inflammatory response, potentially limiting the immune system to counteract the infection. The impact of antibiotic resistance and virulence determinants on clinical outcome of neonatal CoNS sepsis warrants additional clinical studies.