摘要
目的分析新生儿败血症相关因素、病原菌分布和耐药情况。方法对南京市妇幼保健院2010—2017年收住的425例新生儿败血症患儿的临床信息、血培养病原菌鉴定和药敏试验结果进行回顾性资料分析，其中早发型新生儿败血症（EOS）和晚发型新生儿败血症（LOS）分别为148例（34.82%）、277例（65.18%）。比较EOS和LOS组患儿间临床特征及检出的病原菌分布差异，计算革兰阴性（G-）菌和革兰阳性（G＋）菌对抗菌药物的耐药率。结果LOS组早产、低出生体重和剖宫产发生率分别为78.70%（218例）、67.15%（186例）和59.57%（165例），均高于EOS组[分别为41.89%（62例）、37.84%（56例）和46.62%（69例）]（P值均〈0.05）；EOS组产妇发热和胎粪样羊水的发生率分别为18.24%（27例）和25.68%（38例），均高于LOS组[分别为7.94%（22例）和5.42%（15例）]（P值均〈0.05）。检出的425株病原菌中，G-菌216株（50.83%），G＋菌201株（47.29%），光滑假丝酵母菌8株（1.88%）。检出率最高的病原菌分别是大肠埃希菌（68株，16.00%）和肺炎克雷伯菌（56株，13.18%）。EOS组溶血葡萄球菌检出率为10.81%（16例），高于LOS组[1.44%（4例）]（P〈0.001）；而肺炎克雷伯菌在LOS组的检出率为15.88%（44例），高于EOS组[8.11%（12例）]（P=0.024）。G＋菌中葡萄球菌属对青霉素（90.32%-100.00%）和头孢菌素类（25.00%-100.00%）抗生素的耐药性普遍较高。检出的G-菌对氨苄西林普遍耐药（83.33%-100.00%），而对氨基糖苷类（0-11.76%）、喹诺酮类（0-17.65%）和β-内酰胺类抗生素的耐药率较低（0- 5.88%）。结论2010—2017年南京市妇幼保健院收住的新生儿败血症患儿中，早产、低出生体重和剖宫产在LOS患儿中发生率较高，而产妇发热和胎粪样羊水则在EOS患儿中发生率较高；检出率最高的病原菌为大肠埃希菌和肺炎克雷伯菌；常见病原菌对常用抗菌药物呈现较高的耐药性。
ObjectiveThis study was designed to identify the relative factors, bacteriological profile and their antibiotic susceptibility pattern of neonatal sepsis.MethodsA retrospective survey was conducted on the clinical information, pathogen identification and antibiotic sensitivity results of 425 newborns with neonatal sepsis admitted to Nanjing Maternity and Child Health Care Hospital from 2010 to 2017. Of the 425 positive blood-cultures, 148 （34.82%） were early-onset neonatal sepsis （EOS） and 277 （65.18%） were late-onset neonatal sepsis （LOS）. Clinical information and pathogen identification were compared between EOS and LOS. Antibiotic sensitivity of gram negative organisms （G-） and gram positive organisms （G＋） were also detected.ResultsThe rates of premature delivery （78.70%, n=218）, low birth weights （67.15%, n=186） and cesarean delivery （59.57%, n=165） were significantly increased in LOS （P〈0.05） compared with those rates in EOS, which were 41.89% （n=62）, 37.84% （n=56） and 46.62% （n=69）. Parturients fever （18.24%, n=27） and meconium like amniotic fluid （25.68%, n=38） were significantly increased in EOS （P〈0.05） compared with those rates in LOS, which were 7.94% （n=22） and 5.42% （n=15）. Among the identified pathogen, the incidence of G- and G＋ bacteria were 216 （50.83%） and 201 （47.29%） respectively, and the rest was Candida glabrata （1.88%, n=8）. Escherichia coli 68 （16.00%） was the predominant isolate followed by Klebsiella pneumoniae （13.18%, n=56）. The detection rate of Hemolytic staphylococcus （10.81%, n=16） was significantly increased in EOS （P〈0.001） compared with LOS （1.44%, n=4）. However, the incidence of Klebsiella pneumonia （5.88%, n=44） was higher in LOS （P=0.024） compared with EOS （8.11%, n=12）. Most of the gram positive isolates exhibited high resistance to penicillin （90.32%-100.00%） and cephalosporin group antibiotics （25.00%-100.00%）. Similarly, the majority of the gram negative isolates showed higher resistance to ampicillin （83.33%-100.00%）, but susceptible to aminoglycosides （0-11.76%）, quinolones （0-17.65%） and β-lactams （0-5.88%）.ConclusionAmong the study population, the percent of preterm, low birth weight and cesarean section were higher in LOS while parturients fever and meconium-like amniotic fluid were higher in EOS. The pathogens with the highest detection rate were Escherichia coli and Klebsiella pneumoniae. The results of antibiotic susceptibility test showed that common pathogens had high resistance to commonly used antibacterial drugs.
作者
陈婷
马慧君
杨静
刘蔚
戴小婷
童华
Chen Ting;Ma Huijun;Yang Jing;Liu Wei;Dai Xiaoting;Tong Hua(Medical Research Center,the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2018年第10期1023-1028,共6页
Chinese Journal of Preventive Medicine
基金
南京市卫生青年人才培养工程（QRX17162）
生殖医学国家重点实验室创新基金（SKLRM-GC201805）
关键词
婴儿
新生
败血症
耐药性
Infant
newborn
Hematosepsis
Antibiotics resistance
