新生儿败血症血培养分析15年间病原菌及药物敏感性变迁

目的分析本院1989年至2004年15年间新生儿败血症病原菌的变迁及耐药状况，为指导临床诊断及合理应用抗生素提供客观依据。方法对本院15年中16117例新生儿感染进行血培养，对分离出的1073株阳性菌株的构成比及对抗生素耐药情况进行总结分析。送检标本按微生物血培养检验进行常规培养、鉴定，按美国国家临床实验室标准委员会（NCCLS）标准判读结果。结果1073株病原菌菌株中，检出革兰阳性球菌655株，占阳性菌株的61．0oA（655／1073）；革兰阳性球菌以葡萄球菌为主（87．8％，575／655）；检出革兰阴性杆菌410株，占阳性菌株的38．2oA（410／1073）。革兰阴性杆菌中，肠杆菌科300株（73．2％，300／410），非发酵菌110株（26．8％，110／410）。15年间新生儿败血症病原菌革兰阳性球菌主要为葡萄球菌（575株），而血浆凝固酶阴性葡萄球菌占75．6％（435／575）；革兰阴性杆菌主要为大肠埃希菌、肠杆菌；非发酵菌主要为假单胞菌、不动杆菌。血浆凝固酶阴性葡萄球菌、大肠埃希菌及肠杆菌，是新生儿败血症中的主要病原菌。条件致病菌中，非发酵菌15年间呈增高趋势。耐药菌逐年增多，革兰阳性菌对青霉素类、红霉素的耐药率逐渐增高，后10年耐药率逐渐增高（超过80％），对苯唑西林、头孢唑啉的耐药率明显增加（高于60％）。革兰阴性杆菌前10年对氨苄西林、羧苄西林耐药率为80％～95oA；近5年来，对氨苄西林耐药率高于80％，对头胞唑林、哌拉西林、头孢噻肟等耐药率超过50％，且对头孢哌酮、头孢他啶耐药率均在增长。病原菌对抗菌药物呈现多重耐药。结论在调查的15年间，新生儿败血症的主要病原菌以血浆凝固酶阴性葡萄球菌、大肠埃希菌及肠杆菌为主，非发酵菌有增高趋势。病原菌对抗菌药物耐药率呈增高趋势，并呈多重耐药。要?

Microbial Etiology and Antimicrobial Susceptibility of Blood Isolates From Neonatal Septicemia: A 15-Year Retrospective Study

Objective To investigate changes and drug fast status of pathogenic bacteria of neonatal septicemia in the past 15 years in Kunming Children＇s Hospital, and provide evidence for clinical diagnosis and reasonable usage of antibiotics. Methods A retrospective study of 1 073 bacterial species isolated from 16 117 cases of neonatal infection was undertaken in the past 15 years. The study was carried out to analyze the constituent ratio and antibiotic resistance of the bacterial strains. The bacterial blood culture and identification was carried out by routine methods, and the result assessment was based on the NCCLS. Results A total of 1 073 blood samples for blood culture were obtained, 655 were Gram-positive cocci, 410 were Gram-negative bacilli, 118 were non-fermentative bacteria. Staphylococcus was found to be the most common strains which accounted for 87. 8%（575/655） of Gram-positive coccus isolates. Enterobacteria accounted for 75. 6%（435/575）, and non-fermentative bacteria was 26. 8%（118/410） of the Gram-negative bacilli isolates respectively. In the past 15 years, the main pathogens of neonatal septicemia of Gram-positive cocci was staphylococci, especially coagulase-negative staphylococci with an occurrence rate of 75. 6%（435/575）. Gram-negative bacilli mainly included E. Coli and enterobacilli. Pseudomonas and acinetobacter were found to be the main non-fermentative pathogenic bacteria. Coagulase-negative, E. Coli and enterobacilli were main causative agents responsible for neonatal septicemia, but a gradual increase in the occurrence of non-fementative bacteria was observed during the past 15 years. The antibiotic resistance of Gram-positive bacteria to penicillin and erythromycin increased gradually, and the overall antibiotic resistance rate was over 80% during the past 10 years. The resistance rate of oxacillin and cefazolin were significantly over 60 %. Over the past 10 years, the resistance of Gramnegative bacteria to ampicillin, carbenicillin ranged from 80% to 95%. In recent 5 yea