连续三年新生儿血培养病原菌种类及耐药性

目的探讨新生儿血培养病原菌分布及其耐药情况。方法回顾性调查2013年1月1日—2015年12月31日某妇幼保健院新生儿重症监护病房(NICU)住院新生儿送检的血培养标本,对血培养及药敏结果采用WHONET5.6软件进行病原菌分布、耐药情况分析。结果血培养标本中共分离菌株255株,包括革兰阴性菌219株(85.88%),革兰阳性菌29株(11.37%),真菌7株(2.75%)。分离细菌主要为肺炎克雷伯菌(157株)、大肠埃希菌(35株)、B族链球菌(13株)。大肠埃希菌对氨苄西林、哌拉西林的耐药率为97.14%、94.29%,对头孢西丁、亚胺培南、美罗培南、厄他培南及阿米卡星均敏感。肺炎克雷伯菌对哌拉西林的耐药率为93.63%,对头孢唑林、头孢呋辛的耐药率为87.90%、85.35%,对阿米卡星敏感。主要革兰阴性菌对酶抑制剂复合制剂(阿莫西林/克拉维酸、替卡西林/克拉维酸)的耐药率均上升,对头孢菌素类药物(头孢他啶、头孢西丁)的耐药率上升,对磺胺类药物(复方磺胺甲口恶唑)的耐药率上升,差异均有统计学意义(均P0.01)。结论肺炎克雷伯菌和大肠埃希菌在该院NICU血流感染中占重要地位,并对多种抗菌药物的耐药率较高,抗感染治疗的经验性用药应结合本地资料。

Species and antimicrobial resistance of pathogens from blood culture of neonates for three consecutive years

ObjectiveTo evaluate the distribution and antimicrobial resistance of pathogens in neonates. MethodsBlood culture specimens from hospitalized neonates in the neonatal intensive care unit (NICU) of a maternal and child heath hospital between January 1, 2013 and December 31, 2015 were investigated retrospectively, blood culture and antimicrobial susceptibility testing results were analyzed with WHONET 5.6 software.ResultsA total of 255 strains were isolated from blood culture specimens, including 219 strains（85.88%） of gram negative bacteria, 29 strains（11.37%） of gram positive bacteria, and 7 strains（2.75%） of fungi. The isolated bacteria were mainly Klebsiella pneumoniae (n=157), Escherichia coli (n=35), and Streptococcus B (n=13). Resistance of Escherichia coli to ampicillin and piperacillin were 97.14% and 94.29% respectively, all were sensitive to cefoxitin, imipenem, meropenem, ertapenem, and amikacin. Resistance rates of Klebsiella pneumoniae to piperacillin, cefazolin, and cefuroxime were 93.63%, 87.90%, and 85.35% respectively, but was sensitive to amikacin. Resistance rates of the main gram negative bacteria to enzyme inhibitor (amoxicillin/clavulanic acid, ticarcillin/clavulanic acid), cephalosporins (ceftazidime, cefoxitin), and sulfonamides (sulfamethoxazole compound) increased, difference were all statistically significant (all P<0.01).ConclusionKlebsiella pneumoniae and Escherichia coli are the major pathogens causing bloodstream infection in NICU, and resistance rates to a multiple antimicrobial agents are high, empirical medication for anti infection treatment should be combined with local data.