新生儿重症监护室中泌尿道感染的流行病学和病原学分析

目的 探讨新生儿重症监护室(NICU)中泌尿道感染(UTI)的流行性和病原学特征,为临床合理选用抗生素提供依据.方法 回顾性分析2005年1月至2006年12月间入住圣路易斯华盛顿大学圣路易斯儿童医院NICU的所有新生儿的住院资料.结果 NICU的住院患儿中UTI的发生率为6.5%,最常见的病原菌是革兰阴性菌(63.7%),其中前3位是大肠埃希菌、肺炎克雷白杆菌和阴沟肠杆菌;革兰阳性球菌占24.8%,主要是肠球菌和凝固酶阴性葡萄球菌(CNS).大肠埃希菌、肺炎克雷白杆菌和阴沟肠杆菌对氨苄青霉素均高度耐药,而对庆大霉素和头孢吡肟则高度敏感.革兰阴性菌中非大肠埃希菌菌属的耐药性高于大肠埃希菌.革兰阳性菌中,肠球菌对氨苄青霉素和万古霉素完全敏感;CNS对青霉素、苯唑青霉素和头孢唑啉完全耐药,对万古霉素和利福平则100%敏感.结论 NICU中泌尿系统感染的病原菌以革兰阴性杆菌最常见.青霉素和氨苄青霉素总体耐药现象严重,已不适合作为一线用药.故有必要在使用抗生素前及时完善病原学检测和药物敏感试验以指导临床合理用药.

The prevalence and pathogenic bacteria and their antibiotic susceptibility of urinary tract infections in NICU

Objective To study the constituent ratio and antimicrobial susceptibility patterns of pathogenic bacteria in patients with urinary tract infection (UTI) in NICU. Methods Data were collected retrospectively of neonates who admitted to NICU in St. Louis Children' s Hospital in Washington University School of Medicine between Jan 1 ,2005 and Dec 31,2006. Results The prevalence of UTI in NICU was 6. 5%. Gram-negative organisms were the most common agents of UTI in NICU,of which Ecoli ranked highest ,followed by Klebiella and Enterobacter cloacae. Of gram-positive organisms Enterococcus species and Coagulase-negative Staphylococci were the most common agents. Cefepime and gentamycin showed high activity against gram-negative organisms. Overall, non-E. coli microorganisms showed more resistances compared with Escherichia coli. The best susceptible antibiotics for gram-positive organisms were vancomycin and rifampin. Almost all gram-negative bacteria showed resistant to ampicillin and all of gram-positive bacteria resistant to penicillin and oxacillin. Conclusion Gram-negative organisms were the most common agents of UTI in NICU in this study. The drug resistance of bacteria is severe,especially to ampicillin and penicillin,which will be no longer the first choice clinically. So urine culture should be examined when initiating antibiotics treatment for UTI.