低出生体重儿败血症病原菌分布及药物敏感性分析
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摘要
目的了解低出生体重儿败血症的病原菌分布和耐药性,为临床低出生体重儿败血症的诊断和抗菌药物的合理使用提供参考。方法对2017年1月-2018年10月入住医院新生儿重症救护中心(NICU)的低出生体重儿(LBWI)血培养阳性结果进行回顾性分析。结果共分离出病原菌726株,革兰阴性菌461株占63.50%,革兰阳性菌252株占34.71%,真菌13株占1.79%。革兰阴性菌中肺炎克雷伯菌占30.80%,产ESBLs检出率为82.39%,耐碳青霉烯肺炎克雷伯菌检出率为2.81%;大肠埃希菌占24.95%,产ESBLs检出率为60.87%。铜绿假单胞菌占9.97%,耐碳青霉稀类铜绿假单胞菌检出率为8.70%。革兰阳性菌中以凝固酶阴性葡萄球菌为主(61.11%),其次为肠球菌(11.90%)、金黄色葡萄球菌(11.11%)和B群链球菌(8.33%),耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCoNS)的检出率分别为87.66%和89.29%。另检出真菌13株,均为白假丝酵母。结论 NICU病区LBWI败血症病原菌以革兰阴性菌为主,多重耐药菌检出率高,临床应引起重视,获得早期病原学诊断、规范抗菌药物的使用,是预防和治疗LBWI感染的关键。
OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the low birth weight infants with septicemia so as to provide guidance for clinical diagnosis of septicemia and reasonable use of antibiotics.METHODS The low birth weight infants(LBWI)who were hospitalized in neonatal intensive care unit(NICU)from Jan 2017 to Oct 2018 were enrolled in the study,and the results of positive blood culture were retrospectively analyzed.RESULTS A total of 726 strains of pathogens were isolated,461(63.50%)of which were gram-negative bacteria,252(34.71%)were gram-positive bacteria,and 13(1.79%)were fungi.Among the gram-negative bacteria,Klebsiella pneumoniae accounted for 30.80%,the isolation rate of ESBLs-producing strains was 82.39%,and the isolation rate of carbapenem-resistant strains was 2.81%;Escherichia coli accounted for24.95%,the isolation rate of ESBLs-producing strains was 60.87%;Pseudomonas aeruginosa accounted for9.97%,and the isolation rate of carbapenem-resistant strains was 8.70%.Among the gram-positive bacteria,coagulase-negative Staphylococcus,Enterococcus spp,Staphylococcus aureus and group B Streptococcus accounted for 61.11%,11.90%,11.11% and 8.33%,respectively;the isolation rates of methicillin-resistant S.aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus(MRCoNS)were 87.66% and 89.29%,respectively.Totally 13 strains of fungi were isolated,all of which were Candida albicans.CONCLUSIONThe gramnegative bacteria are dominant among the pathogens isolated from the LBWI with septicemia of NICU,the isolation rate of multidrug-resistant organisms is high,and it is necessary for the hospital to attach great importance to the strains,acquire the early etiological diagnosis and reasonably use antibiotics so as to prevent and treat the infections in the LBWI.
OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the low birth weight infants with septicemia so as to provide guidance for clinical diagnosis of septicemia and reasonable use of antibiotics.METHODS The low birth weight infants(LBWI)who were hospitalized in neonatal intensive care unit(NICU)from Jan 2017 to Oct 2018 were enrolled in the study,and the results of positive blood culture were retrospectively analyzed.RESULTS A total of 726 strains of pathogens were isolated,461(63.50%)of which were gram-negative bacteria,252(34.71%)were gram-positive bacteria,and 13(1.79%)were fungi.Among the gram-negative bacteria,Klebsiella pneumoniae accounted for 30.80%,the isolation rate of ESBLs-producing strains was 82.39%,and the isolation rate of carbapenem-resistant strains was 2.81%;Escherichia coli accounted for24.95%,the isolation rate of ESBLs-producing strains was 60.87%;Pseudomonas aeruginosa accounted for9.97%,and the isolation rate of carbapenem-resistant strains was 8.70%.Among the gram-positive bacteria,coagulase-negative Staphylococcus,Enterococcus spp,Staphylococcus aureus and group B Streptococcus accounted for 61.11%,11.90%,11.11% and 8.33%,respectively;the isolation rates of methicillin-resistant S.aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus(MRCoNS)were 87.66% and 89.29%,respectively.Totally 13 strains of fungi were isolated,all of which were Candida albicans.CONCLUSIONThe gramnegative bacteria are dominant among the pathogens isolated from the LBWI with septicemia of NICU,the isolation rate of multidrug-resistant organisms is high,and it is necessary for the hospital to attach great importance to the strains,acquire the early etiological diagnosis and reasonably use antibiotics so as to prevent and treat the infections in the LBWI.
引文
[1]中华医学会儿科学分会新生儿学组,中华医学会中华儿科杂志编辑委员会.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
[2]马珏瑞,华子瑜.新生儿败血症生物标志物研究进展[J].儿科药学杂志,2016,3(22):51-55.
[3]刘瑜,王琍琍,曹秀菁.新生儿败血症病原菌及其耐药性六年的变迁[J].中国感染控制杂志,2016,8(15):537-541.
[4]Clinical and Laboratory Standard Institue.Performance standards for antimicrobial susceptibility setting[S].M100-S18 CLSI,2008:100.
[5]Lamaba M,Sharma R,Sharma D,et al.Bacteriological spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India[J].J Matern Fetal Neonatal Med,2016,29(24):3993-3998.
[6]李燕,潘新年,韦秋芬,等.新生儿败血症病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(3):686-687.
[7]余艳芳,唐丽华,金凤玲.耐碳青霉烯类铜绿假单胞菌的耐药性分析[J].中华医院感染学杂志,2014,24(6):1323-1327.
[8]Jardine LA,Sturgess BR,Inglis GD,et al.Neonatal blood cultures:effect of delayed entry into the blood culture machine and bacterial concentration on the time to positive growth in a simulated model[J].J Paediatr Child Health,2009,45(4):210-214.
[9]Giuffre M,Bonura C,Cipolla D,et al.CMRSA infection in the neonatal intensive care unit[J].Expert Rev Anti Infect Ther,2013,11(5):499-509.
[10]阮培森,吴军华.新生儿重症监护病房内耐甲氧西林金黄色葡萄球菌感染[J].中国微生态学杂志,2017,29(1):118-121.
[11]Simonsen KA,Anderson Berry AL,Delair SF,et al.Earlyonset neonatal sepsis[J].Clin Microbiol Rev,2014,27(1):21-47.
[2]马珏瑞,华子瑜.新生儿败血症生物标志物研究进展[J].儿科药学杂志,2016,3(22):51-55.
[3]刘瑜,王琍琍,曹秀菁.新生儿败血症病原菌及其耐药性六年的变迁[J].中国感染控制杂志,2016,8(15):537-541.
[4]Clinical and Laboratory Standard Institue.Performance standards for antimicrobial susceptibility setting[S].M100-S18 CLSI,2008:100.
[5]Lamaba M,Sharma R,Sharma D,et al.Bacteriological spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India[J].J Matern Fetal Neonatal Med,2016,29(24):3993-3998.
[6]李燕,潘新年,韦秋芬,等.新生儿败血症病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(3):686-687.
[7]余艳芳,唐丽华,金凤玲.耐碳青霉烯类铜绿假单胞菌的耐药性分析[J].中华医院感染学杂志,2014,24(6):1323-1327.
[8]Jardine LA,Sturgess BR,Inglis GD,et al.Neonatal blood cultures:effect of delayed entry into the blood culture machine and bacterial concentration on the time to positive growth in a simulated model[J].J Paediatr Child Health,2009,45(4):210-214.
[9]Giuffre M,Bonura C,Cipolla D,et al.CMRSA infection in the neonatal intensive care unit[J].Expert Rev Anti Infect Ther,2013,11(5):499-509.
[10]阮培森,吴军华.新生儿重症监护病房内耐甲氧西林金黄色葡萄球菌感染[J].中国微生态学杂志,2017,29(1):118-121.
[11]Simonsen KA,Anderson Berry AL,Delair SF,et al.Earlyonset neonatal sepsis[J].Clin Microbiol Rev,2014,27(1):21-47.