311例新生儿败血症病原体分离及其耐药性分析

目的分析新生儿重症监护病房新生儿败血症的病原体分布、临床特点、细菌耐药情况及治疗效果。方法回顾性分析新生儿重症监护病房新生儿败血症311例患儿的临床资料。结果早发型败血症患者中,病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、B族溶血性链球菌、屎肠球菌等;晚发型败血症患者中,依次为凝固酶阴性葡萄球菌、肺炎克雷伯菌、大肠杆菌、铜绿假单胞菌、白色念珠菌等。早发型和晚发型败血症中都是凝固酶阴性葡萄球菌败血症发生率最高,且耐药率很高。肺炎克雷伯菌和大肠杆菌中产超广谱β-内酰胺酶高,感染致败血症病情危重。肺炎克雷伯菌是医院感染的主要致病菌,占50%。结论凝固酶阴性葡萄球菌已成为新生儿血培养的首位菌,其耐药性日渐严重。肺炎克雷伯菌是新生儿重症监护病房内医院感染的重要致病菌,它和大肠杆菌败血症的病情均凶险,病死率高。

Pathogen Isolation and Drug-resistance Analysis of 311 Neonatal Sepsis Cases

Objective To analysis the distribution of pathogens,clinical features,anti-microbial resistance and treatment of neonatal sepsis in neonatal intensive care unit（NICU）.Methods All the clinical data of 311 neonatal sepsis in NICU was retrospectively analyzed.Results In the early onset sepsis（EOS）,pathogens were as follows：Coagulase negative Staphylococcus（CONS）,Escherichia coli（E.coli）,Klebsiella pneumoniae,Group B streptococcus（GBS）,Enterococcus Faecom,et al,In the late onset sepsis（LOS）,pathogens followed by CONS,Klebsiella pneumoniae,E.coli,Pseudomonas aeruginosa,Candida albicans,et al..Both in EOS and LOS,CONS sepsis had the highest incidence and a high rate of anti-microbial resistance.Klebsiella pneumoniae and E.coli had high production of Extended-Spectrum β-lactamase（EBSLs）,with severe patient＇s condition once sepsis occurred.Klebsiella pneumoniae was the major pathogen causing neonatal nosocomal infection,accounting for 50%.Conclusion CONS has become the first neonatal blood culture bacteria,its anti-microbial resistance has become increasingly serious.Klebsiella pneumoniae is the major pathogen causing neonatal nosocomal infection,klebsiella pneumoniae and E.coli sepsis are all dangerous and with high mortality.