血培养阳性新生儿败血症214例临床特点及病原菌耐药分析

目的了解新生儿败血症的临床特点、病原菌分布及耐药情况,有利于临床合理使用抗生素。方法采用回顾性研究方法对山西省儿童医院新生儿内科2006年1月至2007年2月收治的214例新生儿败血症病例的临床特点及血培养菌株和细菌耐药性进行分析。结果208例均为单一菌种生长,6例为两种菌种生长,其中以凝固酶阴性葡萄球菌(CNS)为主,占总分离率的60.5%,余为凝固酶阳性葡萄球菌(金黄色葡萄球菌)、粪肠球菌、屎肠球菌、G群链球菌、革兰阳性短状杆菌等。葡萄球菌对青霉素、苯唑西林、红霉素的耐药率均在55%以上,敏感药物有万古霉素、氟喹诺酮类、氨基糖苷类。革兰阴性杆菌对头孢菌素类耐药率平均为55.6%,敏感药物有亚胺培南、万古霉素、丁胺卡那霉素。结论新生儿败血症临床表现缺乏特异性,对可疑败血症患儿应及早进行病原学检测及药敏试验,并根据病原菌特点和药敏结果合理地选择抗生素。

Clinical characteristics and antibiotic resistance in 214 cases of culture-positive neonatal septicemia

Objective To investigate the clinical characteristics, distribution and antibiotic resistance of pathogens related to neonatal septicemia and to provide evidence for reasonable use of antibiotics in clinical practices. Methods A retrospective study was carried out on 214 cases of neonatal septicemia admitted to Department of Neonatal Medicine, Shanxi Provincial Children's Hospital between January 2006 and February 2007. The clinical characteristics, blood culture-identified bacterial strains and antibiotic resistance in these cases were analyzed. Results Of 214 cases, 208 involved infection with a single bacterium and 6 involved two bacteria, comprising 133 strains of coagulase-negative staphylococci (CNS) seen in 60.45% of total isolates, as well as coagulase-positive staphylococci (staphylococcus aureus), enterococcus faecalis, enterococcus faecium, Streptococcus group G, and G Brachybacteria. Antimicrobial resistance to penicillin, oxacillin, or erythromycin was detected in over 55% of staphylococcus aureus strains, for which, the sensitive drugs included vancomycin, fluoroquinolones and aminoglycosides. Antimicrobial resistance to cephalosporins was noted in 56% of Gram-negative bacilli, which appeared susceptible to imipenem, vancomycin and kanamycin. Conclusion Owing to non-specific clinical features in neonatal sepsis, suspected cases should be subjected to early evaluation in etiology and drug susceptibility test, as well as proper use of antibiotics based on laboratory findings.