NICU早产儿细菌定植及相关因素的研究
摘要
目的：早产儿尤其是极低出生体重儿和超低出生体重儿由于自身免疫功能低下，缺乏抗细菌定植的能力，加之住院时间较长，接受较多有创性的检查和治疗，使细菌定植的危险因素大大增加。另外，早产儿广谱抗生素的使用，易使细菌产生耐药性，尤其严重的是临床上已发现一些耐药菌目前尚无可靠的治疗药物。NICU面临的很大难题是细菌定植后引起院内感染和细菌耐药性。本课题旨在研究NICU中住院早产儿的细菌定植状况及定植菌的耐药性。
方法：对2006年1月至2006年8月间在北京华信医院新生儿重症监护病房住院治疗的早产儿进行细菌学监测，于入院时和入院后每周常规做咽拭子及直肠拭子培养，收集每位早产儿的临床及实验室资料，对结果进行统计学分析。
结果：49例早产儿共培养出156株定植菌，其中产ESBLs79株，入院当天即有细菌定植者6例，定植菌以革兰阴性杆菌为主(占62.8％)，主要对广谱β-内酰胺类抗生素耐药，美罗培南和亚胺培南在目前所用抗生素中对革兰阴性杆菌敏感性最高。革兰阳性菌中对万古霉素和替考拉宁敏感性最高。
结论：应对NICU中住院的早产儿进行细菌学监测，根据监测结果判断细菌定植状态以便及时采取保护措施，另外要选择敏感的抗生素，对控制早产儿感染起到重要的作用。
Objective: The danger factors of bacterial planting increase greatly in the prematureinfants, especially-extremely low and ultra-low birth weight infants because of their lowimmune functions, lacking of anti-bacterial planting capacity, additionally longer hospitalstay and more invasive examination and treatment. In addition, the use of broad-spectrum antibiotic on the premature infants result in bacterials drug resistance easily.Moreover, the worse condition which has been found is that there is no reliable iatricalmedicine of bacteria drug resistance. The great problems which NICU is facing to are theinfection caused by bacterial planting and bacterial drug resistance. The paper detectedbacterial planting and the drug resistance of bacterial planting drug on premature infants inNICU.
Methods: Bacteriological monitoring was performed on the premature infants who weretreated in the ward of infants' serious illness in Beijing HuaXin hospital between January2006 and August 2006. Conventional throat swab and intestinum swab were done once aweek since they entered the hospital. Clinical and laboratory datas of every prematureinfant were collected, then the results were analyzed statistically.
Result: 156 bacterial plantings were cultivated from the 49 premature infants in all,among which 79 ESBLs were produced. There were six cases of bacterial planting on theday when the infant entered the hospital, most of which(62.8％) were gram-negativebacillus, such as Klebsiella pneumonia subspecies and Escherichia coli, which are drug-fastto broad-spectrumβlactams. Meropenem and imipenem were the most sensitiveantibiotics being used currently to the gram-negative bacillus. Gram-positive coccus weresensitive to the vancomycin and teicoplanin.
Conclusion: Bacteriological monitoring is rather necessary to the NICU hospitalizedpremature infants, then we can estimate the state of the bacterial planting according to theresults of monitoring and take protective measures in time. Moreover, we should selectsensitive antibiotics to control the infections of premature infants.
方法：对2006年1月至2006年8月间在北京华信医院新生儿重症监护病房住院治疗的早产儿进行细菌学监测，于入院时和入院后每周常规做咽拭子及直肠拭子培养，收集每位早产儿的临床及实验室资料，对结果进行统计学分析。
结果：49例早产儿共培养出156株定植菌，其中产ESBLs79株，入院当天即有细菌定植者6例，定植菌以革兰阴性杆菌为主(占62.8％)，主要对广谱β-内酰胺类抗生素耐药，美罗培南和亚胺培南在目前所用抗生素中对革兰阴性杆菌敏感性最高。革兰阳性菌中对万古霉素和替考拉宁敏感性最高。
结论：应对NICU中住院的早产儿进行细菌学监测，根据监测结果判断细菌定植状态以便及时采取保护措施，另外要选择敏感的抗生素，对控制早产儿感染起到重要的作用。
Objective: The danger factors of bacterial planting increase greatly in the prematureinfants, especially-extremely low and ultra-low birth weight infants because of their lowimmune functions, lacking of anti-bacterial planting capacity, additionally longer hospitalstay and more invasive examination and treatment. In addition, the use of broad-spectrum antibiotic on the premature infants result in bacterials drug resistance easily.Moreover, the worse condition which has been found is that there is no reliable iatricalmedicine of bacteria drug resistance. The great problems which NICU is facing to are theinfection caused by bacterial planting and bacterial drug resistance. The paper detectedbacterial planting and the drug resistance of bacterial planting drug on premature infants inNICU.
Methods: Bacteriological monitoring was performed on the premature infants who weretreated in the ward of infants' serious illness in Beijing HuaXin hospital between January2006 and August 2006. Conventional throat swab and intestinum swab were done once aweek since they entered the hospital. Clinical and laboratory datas of every prematureinfant were collected, then the results were analyzed statistically.
Result: 156 bacterial plantings were cultivated from the 49 premature infants in all,among which 79 ESBLs were produced. There were six cases of bacterial planting on theday when the infant entered the hospital, most of which(62.8％) were gram-negativebacillus, such as Klebsiella pneumonia subspecies and Escherichia coli, which are drug-fastto broad-spectrumβlactams. Meropenem and imipenem were the most sensitiveantibiotics being used currently to the gram-negative bacillus. Gram-positive coccus weresensitive to the vancomycin and teicoplanin.
Conclusion: Bacteriological monitoring is rather necessary to the NICU hospitalizedpremature infants, then we can estimate the state of the bacterial planting according to theresults of monitoring and take protective measures in time. Moreover, we should selectsensitive antibiotics to control the infections of premature infants.
引文
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2. Sto11 BJ, Gordon T, Korones SB, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network JPediatr, 1996, 129:72-80
3. Stoll BJ, Gordon T, Korones SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network J Pediatr, 1996, 129: 63-71
4. Jacobson KL, Cohen SH, Inciardi JF, et al. The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group Ibeta-lactamase-producing organisms. Clin Infect Dis, 1995, 21:1107-1113
5. Griffin MP, Morman, JR. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. Pediatrics, 2001, 107 : 97-104
6. Berger C, Uehlinger J, Ghelfi D, et al. Comparison of C reactive protein and white blood cell count with differential in neonates at risk for septicaemia. Eur JPediatr, 1995, 154: 138-144
7. NCCLS.Performance standards for antimicrobial susceptibility testing.Fourteenth informational supplement.NCCLS document M100-S14[S].Wayne , Pennsylvania.National Committee for Clinical Laboratory Standards, 2004, 24(1): 1
8. Hamilton-Miller JM. Vancomycin-resistant staphyloocus aureus, A real and present danger? Infection, 2002, 3:118-124
9. Lopez SJB, Coto CD, Fernandez CB, et al. Neonatal sepsis of nosocomial origin: an epidemiological study from the "Grupo de Hospitales Castrillo". J Perinat Med 2002; 30(2): 149-157
10. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110(2 Pt 1): 285-291
11. Yu JL, Wu SX, Jia HQ. Study on antimicrobial susceptibility of bacteria causing neonatal infections:a 12 year study (1987-1998). Singapore Med J, 2001,42(3): 107-110
12．万伟琳，王丹华．新生儿败血症90例临床回顾．中国实用儿科杂志，1999，14(7)：417-419
13．杨锦红，李向阳，张楚南．新生儿败血症的病原菌及耐药性分析．中华医院感染学杂志2003，13(6)：572-574
14．靳绯，刘红，李克京．等．新生儿监护病房院内感染情况的分析．中国医刊，2002，37：44
15．何少茹，黄爱伟，农绍汉．等．NICU院内感染细菌分布情况及耐药性研究．临床儿科杂志，2005，23(6)：360-363
16. Knox JR. Extended-spectrum and inhibitor-resistant TEM-typeβ-lactamases: mutations, specificity, and three-dimensional structure. Antimicrob Agents Chemother, 1995; 39(12): 2593-2601.
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