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目的:了解新生儿败血症的主要病原菌及其耐药情况,减少临床应用抗生素的盲目性及耐药菌的产生。方法:采用BactAlert120全自动血培养仪及VITEK32全自动微生物分析仪对2005年7月～2007年12月间新生儿科送检的可疑败血症2096份血标本进行培养、鉴定及药敏试验。结果:共分离出447株病原菌,阳性率为21.3%。检出革兰氏阳性菌429例,占96.0%,其中凝固酶阴性葡萄球菌和金黄色葡萄球菌分别占68.3%和19.7%,对多种抗生素耐药,对青霉素的耐药率分别为98.7%和98.9%,对苯唑西林的耐药率分别为88.5%和72.7%,对红霉素的耐药率分别为87.9%和89.8%,对万古霉素100.0%敏感;64.8%金黄色葡萄球菌和82.0%凝固酶阴性葡萄球菌为耐甲氧西林葡萄球菌。447例阳性标本中,肠球菌占7.8%,对万古霉素敏感率达95.3%。检出革兰氏阴性菌18例,占4.0%,其中大肠埃希菌占首位,其次为鲍曼不动杆菌、铜绿假单胞菌,对亚胺培南和阿米卡星100.0%敏感。结论:多重耐药的耐甲氧西林葡萄球菌是新生儿败血症的主要病原菌,肠球菌感染有不断增加的趋势,肠球菌已成为新生儿败血症的重要病原菌。临床医师应根据细菌鉴定及药敏试验选择敏感药物治疗。
Objective: To understand the main pathogens of neonatal sepsis and its drug resistance, reduce the blindness of antibiotics in clinical application and the generation of drug-resistant bacteria. Methods: Totally 2096 blood samples of suspicious sepsis were collected from neonatology department between July 2005 and December 2007 with BactAlert120 automatic blood culture instrument and VITEK32 automatic microorganism analyzer. Results: A total of 447 strains of pathogens were isolated, the positive rate was 21.3%. Gram-positive bacteria were detected in 429 cases, accounting for 96.0%, of which coagulase-negative staphylococcus aureus and staphylococcus aureus accounted for 68.3% and 19.7%, respectively, resistant to multiple antibiotics and resistant rates to penicillin were 98.7% And 98.9% respectively. The resistance rates to oxacillin were 88.5% and 72.7%, respectively. The resistance rates to erythromycin were 87.9% and 89.8%, respectively, and were sensitive to 100.0% of vancomycin. Staphylococcus aureus And 82.0% coagulase-negative staphylococci were methicillin-resistant staphylococci. Among 447 positive samples, Enterococcus accounted for 7.8%, and the sensitivity to vancomycin was 95.3%. Gram-negative bacteria were detected in 18 cases (4.0%), of which Escherichia coli accounted for the top, followed by Acinetobacter baumannii and Pseudomonas aeruginosa, which were 100.0% sensitive to imipenem and amikacin. Conclusion: The multi-drug resistant methicillin-resistant Staphylococcus is the main pathogen of neonatal septicemia. The enterococcal infection is continuously increasing. Enterococcus faecium has become an important pathogen of neonatal sepsis. Clinicians should choose sensitive drugs based on bacterial identification and susceptibility testing.