新生儿重症监护病房血培养结果分布及阳性菌耐药性分析

摘要

目的：了解青岛某妇女儿童医院新生儿重症监护病房血培养的细菌分布及耐药性特点。方法：对2013.1月-2013.12月青岛某妇女儿童医院新生儿重症监护病房（NICU）送检的血培养结果进行回顾性统计分析。结果：1年时间共收到新生儿重症监护病房血培养标本423例，培养阳性结果57例，占13.48%.其中革兰阳性菌31例，占54.39%，革兰阴性杆菌25例，占43.86%，真菌1例，占1.75%.各种革兰阳性菌均敏感的药物是万古霉素、利奈唑胺、呋喃妥因和替加环素，敏感性为100%；革兰阴性菌主要是大肠埃希菌和肺炎克雷伯菌。大肠埃希菌中产ESBLS株占37.5(3/8)，肺炎克雷伯菌种产ESBLS株为100%；这两种革兰阴性杆菌均敏感的药物是亚胺培南.、哌拉西林/他唑巴坦、厄他培南、阿米卡星和妥布霉素。结论：该院新生儿重症监护病房血培养病原菌中革兰阳性菌以凝固酶阴性菌为主，革兰阴性菌中主要是大肠埃希菌和肺炎克雷伯菌，各种细菌都在不同程度上表现为多重耐药性，应重视新生儿重症监护室血培养及药敏结果，根据药敏结果选用敏感性抗菌药物，以提高疗效，防止耐药菌的产生和传播。%Objective: To investigate the characteristics of the distribution and drug resistance of bacteria in blood culture of neonatal intensive care unit of a Qingdao hospital for women and children.Methods:Blood culture results of the neonatal intensive care unit (NICU) from 2013.1 to 2013.12 in a Qingdao Hospital of Women and Children were analyzed retrospectively.Results:a annual 423 blood culture specimens were received, of which 57 cases were positive accounting for 13.48%. 31 cases of gram positive bacteria among positive cases accounted for 54.39%, 25 cases of gram negative bacilli accounted for 43.86% respectively, 1 fungi case accounted for 1.75% at last. The drugs which a variety of gram positive bacteria were on a 100% sensitivity to vancomycin, linezolid nitrofurantoin and tigecycline; Escherichia coli and Klebsiella pneumoniae of gram negative bacterias were also completely sensitive to these drugs. Of all Escherichia coli, ESBLS-producing-Escherichia coli accounted for 37.5%(3/8), Klebsiella pneumoniae were 100% ESBLS positive; both of the gram negative bacilli were sensitive to Imipenem, Piperacillin / tazobactam,Ertapenem, Amikacin and tobramycin.Conclusions:Most of the pathogen of gram positive bacteria in blood culture obtained from the NICU of the hospital were coagulase negative bacteria, meanwhile Escherichia coli and Klebsiella pneumoniae were the main member of gram negative ones. The blood culture results and bacteria sensitivity results of NICU should be pay attention to because of all kinds of bacteria were presenting resistant to multiple drugs. In order to improve the curative effect and prevent the occurrence and spread of resistant bacteria, antibacterials should be chosen effectively according to the results of drug sensitivity.