586例败血症病原菌分布及耐药性分析

目的了解常德市第一人民医院临床分离的败血症病原学分布及对常用抗生素的耐药情况,为临床提供诊断和治疗的依据。方法回顾性总结常德市第一人民医院2002年1月～2007年4月临床确诊的586例败血症病原菌分布特点及药敏结果。结果共检出病原菌613株,其中G＋菌426株（69.5%）,G-菌163株（26.6%）,真菌24株（3.9%）。检出较多的为表皮葡萄球菌（24.5%）、金黄色葡萄球菌（23.2%）、大肠埃希菌（8.3%）、棒状杆菌（5.9%）和链球菌（5.7%）。儿科患者中G＋菌感染比例为78.7%,高于成人败血症患者（55.7%）。药敏试验显示主要致病菌均存在多重耐药,G＋致病菌对万古霉素耐药性最低,G-致病菌对碳青霉烯类抗生素耐药率最低,可将此2类抗生素作为败血症治疗的首选药物。结论近年来常德市第一人民医院败血症患者以G＋菌感染为主,且呈现多重耐药倾向,值得进一步研究。临床应依据本地区药敏结果优化选择抗生素,并采用合理的手段降低耐药率的发生。     

新生儿败血症血培养分析15年间病原菌及药物敏感性变迁

目的分析本院1989年至2004年15年间新生儿败血症病原菌的变迁及耐药状况，为指导临床诊断及合理应用抗生素提供客观依据。方法对本院15年中16117例新生儿感染进行血培养，对分离出的1073株阳性菌株的构成比及对抗生素耐药情况进行总结分析。送检标本按微生物血培养检验进行常规培养、鉴定，按美国国家临床实验室标准委员会（NCCLS）标准判读结果。结果1073株病原菌菌株中，检出革兰阳性球菌655株，占阳性菌株的61．0oA（655／1073）；革兰阳性球菌以葡萄球菌为主（87．8％，575／655）；检出革兰阴性杆菌410株，占阳性菌株的38．2oA（410／1073）。革兰阴性杆菌中，肠杆菌科300株（73．2％，300／410），非发酵菌110株（26．8％，110／410）。15年间新生儿败血症病原菌革兰阳性球菌主要为葡萄球菌（575株），而血浆凝固酶阴性葡萄球菌占75．6％（435／575）；革兰阴性杆菌主要为大肠埃希菌、肠杆菌；非发酵菌主要为假单胞菌、不动杆菌。血浆凝固酶阴性葡萄球菌、大肠埃希菌及肠杆菌，是新生儿败血症中的主要病原菌。条件致病菌中，非发酵菌15年间呈增高趋势。耐药菌逐年增多，革兰阳性菌对青霉素类、红霉素的耐药率逐渐增高，后10年耐药率逐渐增高（超过80％），对苯唑西林、头孢唑啉的耐药率明显增加（高于60％）。革兰阴性杆菌前10年对氨苄西林、羧苄西林耐药率为80％～95oA；近5年来，对氨苄西林耐药率高于80％，对头胞唑林、哌拉西林、头孢噻肟等耐药率超过50％，且对头孢哌酮、头孢他啶耐药率均在增长。病原菌对抗菌药物呈现多重耐药。结论在调查的15年间，新生儿败血症的主要病原菌以血浆凝固酶阴性葡萄球菌、大肠埃希菌及肠杆菌为主，非发酵菌有增高趋势。病原菌对抗菌药物耐药率呈增高趋势，并呈多重耐药。要?     

Neonatal mortality pattern in rural based medical college hospital

The present study was undertaken to establish priorities in neonatal care and to find out neonatal mortality pattern in a rural based medical college hospital. One hundred and twentythree neonatal deaths out of 1461 live births constituted the study material. The neonatal mortality rate was 84.2/1000 live births. The mortality in preterm, full term and post term infants was 43.13,4.02,7.02 percent respectively (p<0.001). The mortality in relation to birth weight was 100 percent (<1000 g); 71.43 percent (1000–1499 g); 37.14 percent (1500–1999 g); 7.63 percent (2000–2499 g) and 2.94 percent (>2500 g). Almost 70 percent of all deaths were because of severe birth anoxia and septicemia (including meningitis) either alone or in combination.     

Outbreak of neonatal septicemia with multidrug resistantKlebsiella Pneumoniae

A nosocomial outbreak of neonatal septicemia due toK. pneumoniae occurred in nursery during June–July, 1991.Klebsiella pneumoniae (Klebocin type 314) was recovered from blood of 33(70.2%) of 47 neonates with septicemia. Multiple drug resistance was observed in all the cases. The same strain ofK. pneumoniae was recovered from the neonates and environment of nursery and labour room as well. The outbreak was attributable to environmental dissemination.     

Chromogenic endotoxin determination in blood — clinical relevance

Summary In a pilot study in 400 patients LPS-quantification in blood using chromogenic substrates, bacterial cultures and bacterial quantification were performed. Decreased plasma levels of antithrombin III and plasminogen were early predictors of gram-negative septicemia, which already were apparant 3 days prior to the first positive LPS-test. It is concluded that daily determinations of LPS may reduce the delay in proper antibiotic therapy.     

Severe sepsis epidemiology: sampling,selection, and society

Three new articles in Critical Care add to an expanding body of information on the epidemiology of severe sepsis. Although there have been a range of approaches to estimate the incidence of severe sepsis, most studies report severe sepsis in about 10 ± 4% of ICU patients with a population incidence of 1 ± 0.5 cases per 1000. Importantly, the availability of ICU services may well determine the number of treated cases of severe sepsis, and it seems clear that these studies are reporting the treated incidence, not the incidence, of severe sepsis. In the future, we must focus on whether all severe sepsis should be treated, and, consequently, what level of ICU services is optimal.     

NEONATAL SEPTICEMIA IN RIYADH, SAUDI ARABIA

Abstract. Ohlsson, A. and Serenius, F. (Division of Perinatology, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia). Neonatal septicemia in Riyadh, Saudi Arabia). Neonatal septicemia in Riyadh, Saudi Arabia. Acta Paediatr Scand, 70: 825, 1981.-Twenty-nine cases of neonatal septicemia from Saudi Arabia are described. A high incidence of prematurity (45 %) and congenital malformations (45 %) were found as predisposing factors. The mortality was 45 %, mainly due to severe malformations and late referrals. Thirty-one percent of the cases grew Salmonella enteritidis species and one case of Bacteroides fragilis septicemia and meningitis is reported. Only two of the organisms isolated were sensitive to ampicillin. The importance of doing studies on neonatal septicemia on a local basis is stressed.     

新生儿败血症83例临床分析

目的:了解引起新生儿败血症的主要细菌分布及抗生素敏感情况,动态观察白细胞计数(WBC)、C-反应蛋白(CRP)、血小板计数(PLT)、白介素-6(IL-6)的变化情况,以指导临床治疗。方法:回顾性分析83例新生儿败血症血培养及药敏试验结果,另选同期无感染症状的81例新生儿作为对照组,测定新生儿败血症组治疗前后以及对照组WBC、CRP、PLT、IL-6,比较相互间差异。结果:83例新生儿败血症患儿大肠埃希菌27例,肺炎克雷伯菌20例,金葡菌14例,绿脓假单胞菌11例,粪肠球菌7例,阴沟肠杆菌4例。大肠埃希菌对碳青霉烯类高度敏感,其次为阿米卡星和3代头孢菌素;肺炎克雷伯菌对碳青霉烯类高度敏感,其次分别为环丙沙星、庆大霉素,对3代头孢菌素普遍耐药,同时对头孢吡肟普遍耐药;金葡菌对万古霉素高度敏感,其次为碳青霉烯类;绿脓假单胞菌对碳青霉烯类高度敏感;粪肠球菌对万古霉素高度敏感,对亚胺培南耐药;阴沟肠杆菌对碳青霉烯类高度敏感。败血症组治疗前CRP阳性率为71.1%,IL-6、CRP、WBC明显高于对照组和恢复期,PLT明显低于对照组和恢复期,与对照组CRP、WBC、PLT计数比较均有明显差异(P<0.001)。83例败血症患儿中治愈61例,好转15例,7例病情无好转家属放弃治疗自动出院,其中4例自动出院后死亡。结论:治疗新生儿败血症时应根据药敏结果选用敏感抗生素治疗,同时动态观察WBC、CRP、PLT、IL-6的变化以反映细菌感染的消退情况,弥补因细菌培养阳性率低及培养周期长的缺陷,有效地控制疾病的发展。     

新生儿败血症的细菌分布与药敏分析

目的探讨我院2007年1月-2010年10月新生儿败血症的细菌分布和敏感性特征。方法回顾分析我院新生儿败血症的临床资料。结果血培养阳性率为6.8%（159/2338）,159例住院的新生儿败血症以革兰阳性球菌为主,占55.3%（88/159）,主要为表皮葡萄球菌、金黄色葡萄球菌、溶血性葡萄球菌、木糖葡萄球菌4种;革兰阴性杆菌占25.2%（40/159）,主要为肺炎克雷伯菌和大肠埃希菌两种,药物敏感性结果葡萄球菌敏感度较好的抗生素为奎宁始霉素/达福普汀、呋喃妥因、呋西地酸、替考拉宁、米诺环素、万古霉素,阴性杆菌敏感较好的抗生素为是亚胺培南、美洛培南和环丙沙星,酶抑制剂的复合物和头孢西丁为中度敏感。结论熟悉本地区细菌分布特点以及细菌的敏感性特征,合理选用抗生素对于新生儿败血症的治疗以及防止细菌耐药有重要意义。     

糖尿病并发败血症16例临床分析

本文报道糖尿病并发的败血症16例,均经血培养证实。致病菌13例为革兰阴性杆菌占81.25％,另3例分别为金黄色葡萄球菌(金葡菌)、表皮葡萄球菌与白色念珠菌。起病均急骤,伴畏寒发热,严重者有神志改变、休克、酮症酸中毒或肺与肝脏迁徒性病灶、血管栓塞性病变、多脏器功能衰竭,病情凶险。病死率高达43.75％。