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目的了解五年来新生儿败血症病菌的变迁及耐药状况,指导临床诊断及合理应用抗生素。方法对2000～2004年住院10489名新生儿感染病例血培养标本中检出的589株病原菌株和耐药状况进行统计分析及临床总结。送检标本应用BacT/ALERT3D血培养仪、VITEK32细菌鉴定仪,按微生物血培养检验常规进行培养、鉴定。药敏试验采用KB纸片扩散法,用金黄色葡萄球菌ATCC29213,大肠埃希菌ATCC25922,铜绿假单胞ATCC27853为质控菌株,用M-H培养基,按美国1999年版NCCLS标准判读结果。结果10489例新生儿血培养标本中阳性病例共589例,血培养阳性率5.6%。589株菌株中检出革兰阳性球菌378株占阳性菌株的64.2%(378/589);革兰阳性球菌以葡萄球菌为主,占阳性球菌的90.7%(343/378);检出革兰阴性杆菌211株占阴性菌株的35.8%(/211/589)%,其中肠杆菌科147株,占阴性杆菌的69.7%,非发酵菌64株占阴性杆菌的30.3%。五年间新生儿败血症病原菌革兰阳性球菌主要为葡萄球菌;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。阳性菌株中葡萄球菌占首位(58.23%),葡萄球菌属中血浆凝固酶阴性葡萄球菌占84.3%(289/343)。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感染的主要病原菌;条件致病菌中非发酵菌呈增高趋势。耐药菌逐年增多,革兰阳性菌对青霉素类、红霉素耐药率>80%、苯唑西林、头孢唑啉耐药率明显增加>60%。革兰阴性菌对氨苄西林耐药率>80%,头胞唑林、哌拉西林、头胞噻肟等耐药率均>50%头孢哌酮、头孢他啶耐药率均在增长。结论五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。要高度重视新生儿败血症病原菌对抗生素多重耐药性现状。
Objective To understand the changes and drug resistance of neonatal sepsis in five years, to guide clinical diagnosis and rational use of antibiotics. Methods 589 strains of pathogens detected in blood culture specimens of 10489 neonates with inpatients from 2000 to 2004 were analyzed statistically and analyzed clinically. The submission specimens should be cultured and identified by BacT / ALERT3D blood culture instrument and VITEK32 bacterial identification instrument according to the routine test of microbial blood culture. Susceptibility test using KB disk diffusion method, with Staphylococcus aureus ATCC29213, Escherichia coli ATCC25922, Pseudomonas aeruginosa ATCC27853 as quality control strains, with M-H medium, according to the United States NCCLS 1999 version of the standard interpretation of the results. Results A total of 5889 positive cases were found in 10489 neonatal blood culture samples, with a positive rate of 5.6% in blood culture. Among the 589 strains, 378 strains of gram-positive cocci were found to be 64.2% (378/589) of the positive strains. Staphylococcus aureus was the predominant strain of gram-positive cocci, accounting for 90.7% (343/378) of the positive cocci; 211 strains of negative bacilli accounted for 35.8% (/ 211/589)% of negative strains, of which 147 were Enterobacteriaceae, accounting for 69.7% of negative bacilli, and 64 strains of nonfermentative bacteria accounted for 30.3% of negative bacilli. Five years of neonatal sepsis pathogens Gram-positive cocci mainly Staphylococcus; Gram-negative bacteria mainly Escherichia coli, Enterobacteriaceae; non-fermenting bacteria are mainly Pseudomonas, Acinetobacter. Staphylococcus positive bacteria (58.23%), Staphylococcus coagulase-negative staphylococcus accounted for 84.3% (289/343). Plasma coagulase-negative staphylococci, Escherichia coli and Enterobacteriaceae are the main pathogens of neonatal sepsis infection; non-fermentative bacteria in the pathogenic bacteria showed an increasing trend. Drug-resistant bacteria increased year by year, Gram-positive bacteria penicillins, erythromycin resistance rate> 80%, oxacillin, cefazolin resistance rate increased significantly> 60%. Gram-negative bacteria resistant to ampicillin> 80%, the drug resistance rate of cefazolin, piperacillin, cefotaxime were> 50% cefoperazone, ceftazidime resistance rates are increasing. Conclusion The main pathogens of neonatal sepsis in five years are coagulase-negative staphylococci, Escherichia coli and Enterobacteriaceae, and the non-fermentative bacteria have an increasing trend. To attach great importance to neonatal sepsis pathogens antibiotic multi-drug resistance status quo.