新生儿病区多重耐药菌分布及耐药性分析

目的:通过对2016 年7 月至2017 年7 月河南省妇幼保健院住院患儿多重耐药菌的临床分布及耐药性分析,为临床抗菌药物的合理应用提供理论依据。 方法:应用珠海迪尔 DL-96 系统和手工实验相结合的方法进行细菌鉴定和抗菌药物敏感性试验,部分药敏试验结合 K-B 纸片扩散法。 药敏试验结果参照美国 CLSI 标准判读,将数据录入 WHONET 软件进行细菌分布及耐药性统计分析。 结果:河南省妇幼保健院在 2016 年 7 月至 2017 年 7 月住院的新生儿共检出阳性菌株 1 754 株,检出多重耐药菌 337 株,占 19.21%。 多重耐药菌中,耐碳青霉烯肺炎克雷伯菌(CRKPN)比例最高,占 45.70%;多重耐药菌主要分布在新生儿重症监护病房(NICU),且在新生儿和其他儿童病区中,CRKPN 检出率最高。 NICU 与新生儿普通病区相比,多重耐药菌和CRKPN 阳性率比较差异有统计学意义(P<0.01);新生儿病区与其他儿童病区相比,多重耐药菌和 CRKPN 阳性率比较差异有统计学意义(P<0.01)。 药敏结果显示肺炎克雷伯菌对氨苄西林耐药率 100%,对哌拉西林/他唑巴坦耐药率 80.3%,对碳青霉烯类药物美罗培南、亚胺培南的耐药率高达 65.2%,对复方磺胺甲噁唑的耐药率最低为 28.8%。 结论:我院新生儿病区多重耐药菌检出率较高,以 CRKPN 为主,提示应加强多重耐药菌株监测和抗菌药物监管。

Analysis of the Distribution and Drug Resistance of Multi-Drug Resistant Bacteria in Neonatal Ward

Objective: To analyze the clinical distribution and drug resistance of hospitalized neonates multi-drug resistant bacteria in Maternal and Child Health Hospital of Henan Province from July 2016 to July 2017, and provide a evidence-based medicine for clinical rational use of antibacterial drugs. Methods: Bacteria identification and antimicrobial susceptibility test were carried out by using the method of Zhuhai Deere DL-96 system and manual experiment. Some drug sensitivity tests were combined with K-B paper diffusion method. The results of drugs susceptibility test were interpreted by the American CLSI standard. The data were fed into WHONET software for statistical analysis of bacterial distribution and drug resistance. Results: A total of 1,754 positive strains were detected from July 2016 to July 2017. There were 337 strains of multi-drug resistant bacteria were detected, the detection rate was 19.21%. The highest proportion of carbapenem-resistant Klebsiella pneumonia (CRKPN) was 45.70%. The cases of multi-drug resistant infections were mainly distributed in neonatal intensive care unit, and the proportion of CRKPN was the highest among all the resistant strains in the neonatal and children ward. Compared with the normal neonatal ward, the positive rate of multi-drug resistant bacteria and CRKPN was statistically significant in NICU (P<0.01). Compared neonatal ward with children ward, the difference between the positive rate of muti-drug resistant bacteria and CRKPN was statistically significant (P<0.01). Drug sensitivity results showed that the resistance rate of Klebsiella pneumoniae to ampicillin was 100%, and to piperacillin was 80.3%. The resistant rate of Klebsiella pneumoniae to carbapenem antibiotics ( meropenem and imipenem) was as high as 65.2%, and to cotrimoxazole was the lowest of 28.8%.Conclusion: The infection rate of multi-drug resistant bacteria is higher in neonatal ward of our hospital, which is mainly resistant to CRKPN, suggesting that the monitoring of multi-drug resistant strains and the supervision of antimicrobial agents should be strengthened.