中山地区新生儿血培养病原菌分布及耐药性分析

目的了解中山地区新生儿血培养病原菌分布及其常见病原菌对抗生素的耐药情况,为指导临床诊断及合理应用抗生素提供客观依据。方法对2007年—2009年在我院新生儿科住院的患儿进行血培养,应用BacT/ALERT 3D全自动血培养仪进行检测,阳性菌株用VITEK-32全自动微生物分析仪进行菌株鉴定及药敏试验。结果3589例新生儿血培养标本共检出病原菌228株,总阳性率为6.35%,其中革兰阳性菌194株,占总分离率的85.09%,革兰阳性菌中以凝固酶阴性葡萄球菌为主;革兰阴性菌28株,占12.28%,革兰阴性菌以大肠埃希菌和肺炎克雷伯杆菌居多。药敏结果显示革兰阳性菌对青霉素G耐药率最高,其次为氨苄西林/舒巴坦、苯唑西林,耐药率均在80%以上。未检出对万古霉素、利奈唑胺、呋喃妥因耐药的菌株。革兰阴性菌中大肠埃希菌、肺炎克雷伯杆菌ESBLs的检出率均为50%,这些菌株对头孢哌酮/舒巴坦、丁胺卡那霉素、左旋氧氟沙星、亚胺培南表现了较低的耐药率。结论本地区新生儿血培养病原菌以革兰阳性菌为主,凝固酶阴性葡萄球菌是主要病原菌,且表现为多重耐药性。对新生儿凝固酶阴性葡萄球菌引起的败血症应加以重视。

Analysis of distribution and antibiotic resistance of pathogens from neonatal blood culture in Zhongshan city

Objective To investigate the distribution and antibiotic resistance of pathogens isolated from neonatal blood culture in Zhongshan city,and provide evidence for clinical diagnosis and reasonable usage of antiviotics.Methods Bact/Alert automated blood culture system was used to culture the blood samples.3 589 blood samples of newborn with positive results of blood cultures from 2007 to 2009 were identified and their drug sensitivity tests were done by VITEK-32 automicroscan.Results 228 pathogenic strains were isolated from 3 589 specimens and the positive rate was 6.35%.Among them,194 strains were gram-positive bacteria（85.09%）,and the coagulase negative staphylococcus was dominant（74.12%）.28 strains were gram-negative bacteria（12.28%）,and the E.coli and Klebsiella pneumoniae were most frequently isolated.The results of drug sensitivity test showed that the resistance rate of gram-positive bacteria to Penicillin G was the highest,the next were Ampinicillin/Sulbactam,Oxacillin,More than 80%of the resistance rate.No Vancomycin,Linezolid and Nitrofurantoin resistant strain was found.Among gram-negative bacteria,the positive rates of E.coli and Klebsiella pneumoniae that produce Extent-spectrum β-lactamases（ESBLs）were both 50%of them.And the resistance rates of them to Cefoperazone/Sulbactam,Amikacin,Levofloxacin,Piperacillin/Tazobactam and Imipenem were rather lower.Conclusion Gram-positive bacteria were the main pathogen causing neonatal septicemia in Zhangshan city.Among them,coagulase negative staphylococcus is the main cause,and it shows a trend of multidrug resistant.So much more attention should be paid to coagulase negative staphylococcus of neonatal septicemia.It is important for the doctors to get the results of blood culture in time in order to give the patients correct antibiotic therapy,improve the cure rate,and reducing resistance of pathogens.