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目的:探讨15 424份新生儿血培养阳性菌谱构成特点,为预防新生儿败血症及合理使用抗生素提供临床参考。方法:回顾性分析2009-2015年新生儿送检血液培养结果,整理培养阳性细菌种类,采用Whonet5.4软件分析新生儿败血症重要病原菌对抗菌素的敏感性。结果:连续7年共送检15 424份新生儿血培养,其中阳性结果883份,平均血培养阳性率为5.7%。菌种分类构成比为:革兰阳性菌61.8%,革兰阴性菌37.6%,真菌0.6%。前6位病原菌分别为:凝固酶阴性葡萄球菌(CNS)432株、大肠埃希菌(ECO)74株、嗜麦芽黄单胞菌(PMA)71株、肺炎克雷伯菌(KPN)70株、无乳链球菌(GBS)42株、金黄色葡萄球菌(SAU)36株,其中CNS甲氧西林耐药率85.9%,SAU中34.4%为耐甲氧西林金黄色葡萄球菌(MRSA),GBS四环素耐药率100%,红霉素耐药率80%,ECO产超广谱β-内酰胺酶(ESBL)率35.9%,KPN产ESBL率60%。结论:新生儿血培养阳性菌种类多,出现多重耐药比例高,需定期总结回顾病原菌流行分布并分析耐药性,为临床防治新生儿败血症及合理用药提供参考和依据。
Objective: To investigate the characteristics of 15 424 neonatal blood culture positive bacteria spectrum and provide clinical reference for the prevention of neonatal sepsis and rational use of antibiotics. Methods: The blood culture results of newborns from 2009 to 2015 were retrospectively analyzed. The positive bacterial species were sorted out. The sensitivity of important pathogens of neonatal sepsis to antibiotics was analyzed by Whonet5.4 software. Results: A total of 15 424 neonatal blood cultures were sent for seven consecutive years, of which 883 were positive. The average positive rate of blood culture was 5.7%. Classification of species composition ratio: Gram-positive bacteria 61.8%, 37.6% of gram-negative bacteria, fungi 0.6%. The first six pathogens were Coagulase-negative Staphylococcus (CNS) 432, Escherichia coli 74, PMA 71 and KPN 70 42 strains of Streptococcus agalactiae (GBS) and 36 strains of Staphylococcus aureus (SAU), among which the methicillin-resistant rate was 85.9% in CNS and 34.4% in SAU were methicillin-resistant Staphylococcus aureus (MRSA) The resistance rate of tetracycline was 100%. The erythromycin resistance rate was 80%. The ESBL-producing ESBL rate was 35.9% and KPN ESBL rate was 60%. Conclusions: There are many positive blood cultures of newborn with high rate of multi-drug resistance. It is necessary to review the epidemic distribution of pathogens and analyze the drug resistance periodically, providing a reference and basis for clinical prevention and treatment of neonatal sepsis and rational drug use.