新生儿败血症病原菌分布特点及耐药分析

摘要

Objective To explore the pathogen characteristics and drug resistance in neonatal sepsis.Methods Retrospective analysis was conducted on the clinical data of 298 cases of neonatal sepsis treated in Shaanxi Province People' s Hospital during the period of January 2010 to December 2014.Drug analysis was done according to the results of blood culture and drug susceptibility.Results Among 298 cases of neonatal sepsis, 108 pathogenic bacteria strains were found in blood culture, among which 61.11% (66/108) were Gram-negative bacteria, 24.07% ( 26/108 ) were Gram-positive bacteria, and 14.82% ( 16/108 ) were Fungi.The first three were Klebsiella pneumoniae (29.63%, 32/108), escherichia coli (13.89%, 15/108) and pseudomons aeruginosa (6.48%, 7/108) in Gram-negative bacteria.Their drug resistance to piperacillin and piperacillin-tazobactam reached 90%, but that to cefoxitin and cefoperazone/sulbactam was low.No bacterium resistant to carbon penicillin antibiotics was found.Of Gram-positive bacteria, the detection rate of staphylococcus epidermidis (24.69%, 60/243), enterococcus faecium (3.70%, 4/108) and staphylococcus haemolyticus (2.78%, 3/108) were highest.Their resistance to erythromycin and oxacillin were rather high but to cefazolin was low.Staphylococci resistant to vancocin and teicoplanin were not found.Conclusion The main pathogens of neonatal sepsis are Gram-negative bacteria, and their drug resistance rates are higher.There is an increasing trend of incidence of fungal sepsis, which needs more attention.%目的 探讨新生儿败血症病原学特点及病菌耐药情况.方法 对2010年1月至2014年12月陕西省人民医院新生儿科的298例新生儿败血症患儿临床资料进行回顾性分析,并根据细菌培养阳性结果 及药敏情况进行药物分析.结果 在298例新生儿败血症患儿中,血培养共获得108株病原菌,其中革兰阴性菌最多,占61.11%(66/108);革兰阳性菌占24.07%(26/108),真菌占14.82%(16/108).在革兰阴性菌中前3位细菌为肺炎克雷伯菌29.63%(32/108)、大肠埃希菌13.89%(15/108)、铜绿假单胞菌6.48%(7/108);其对哌拉西林及哌拉西林他唑巴坦耐药率均高达90%以上,而对头孢西丁、头孢哌酮/舒巴坦耐药率较低;未检出对碳青霉素类抗生素耐药菌.在革兰阳性菌中以表皮葡萄球菌12.96%(14/108)、屎肠球菌3.70%(4/108)、溶血葡萄球菌2.78%(3/108)检出率最高;对红霉素、苯唑西林的的耐药率较高;对头孢唑啉的耐药率较低,尚未发现对糖肽类抗生素万古霉素、替考拉宁耐药的葡萄球菌.结论 新生儿败血症病原菌以革兰阴性杆菌为主,且耐药率较高,同时真菌败血症的发生率有上升趋势,需警惕.