南京地区新生儿血培养病原菌分布及耐药性分析

目的:了解南京地区新生儿败血症病原菌分布及其耐药情况,为临床合理选择抗生素提供参考。方法:收集2009年1月-2011年9月我院住院新生儿血培养标本1546例,分析其病原菌分布及耐药性。结果:1546例新生儿血培养标本共检出细菌186株,总阳性率为12.03%,因无临床表现支持而被视为假菌血症者7例,污染率为3.76%(7/186)。其中革兰阳性菌129株,占总分离菌的72.07%,革兰阳性菌以凝固酶阴性葡萄球菌为主,占革兰阳性菌的76.74%,占总分离菌的55.31%;革兰阴性菌50株,占总分离菌的27.93%,革兰阴性菌以肺炎克雷伯菌居多,占革兰阴性菌的42.00%,占总分离菌的11.73%。革兰阳性菌对抗生素耐药率最高的为青霉素,其次为红霉素,对万古霉素、哌拉西林/他唑巴坦、阿米卡星以及左氧氟沙星表现了较低的耐药率;革兰阴性菌对抗生素耐药率最高的为氨苄西林,其次为哌拉西林、头孢唑林、氨曲南,对亚胺培南、头孢吡肟、阿米卡星、左氧氟沙星以及加酶抑制剂的复合制剂表现了较低的耐药率。结论:凝固酶阴性葡萄球菌是南京地区近2年新生儿败血症最常见的病原菌,其次为肺炎克雷伯菌,对常用抗生素均有不同程度的耐药。

Analysis of Distribution and Antibiotic Resistance of Pathogenic Bacteria of Blood Cultures in Newborns in Nanjing Area

OBJECTIVE: To investigate distribution and antibiotic resistance of pathogens causing neonatal septicemia and to provide evidence for reasonable use of antibiotics in clinic in Nanjing area. METHODS: 1 546 neonatal blood samples were collected from our hospital during Jan. 2009-Sept. 2011. The distribution and antibiotic resistance of pathogens causing neonatal septicemia were analyzed. RESULTS: 186 pathogenic strains were isolated from 1 546 specimens and the positive rate was 12.03%. 7 cases were considered as false bacteremia due to non-clinical support, in which contamination rate was 3.76% (7/186). Among them, 129 strains were Gram-positive bacteria (72.07%), and the coagulase negative staphylococcus was dominant, accounting for 76.74% of positive bacteria, and accounting for 55.31% of the total separated strains. 50 strains were Gram-negative bacteria (27.93%), and the Klebsiella pneumoniae was the most frequently isolated, accounting for 42.00% of negative bacteria, and accounting for 11.73% of the total separated strains. The resistance rate of Gram-positive bacteria to penicililn was the highest, followed by erythromycin. The resistance rate of them to vancomycin, piperacillin/tazobactam, amikacin and levofloxacin were rather lower. The resistance rate of Gram-negative bacteria to ampicillin was the highest, the next were followed by piperacillin, cefazolin and aztreonam. The resistance rate of them to imipenem, cefepime, amikacin, levofloxacin and enzyme inhibitor combinations were rather lower. CONCLUSIONS: Coagulase-negative staphylococcus is the primary pathogens causing neonatal septicemia in Nanjing area in recent 2 years, followed by Klebsiella pneunwniae. Drug resistance varies in different bacteria. It is important for reasonable use of antibiotics to know distribution and antibiotic resistance of pathogens.