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目的探讨新生儿败血症病原菌分布及耐药情况。方法选取2010-2015年内蒙古通辽市医院收治的268例血培养阳性的败血症患儿,分为早发型和晚发型组,分析其临床特点、病原菌分布及耐药情况。结果早发型败血症病原菌以革兰阴性菌为主(58.3%),其中大肠埃希菌(31.2%),肺炎克雷伯杆菌(23.9%)。晚发型败血症病原菌以革兰阳性菌为主(65.1%),其中包括凝固酶阴性葡萄球菌(46.5%)、屎肠球菌(11.6%)。革兰阳性菌对万古霉素敏感,对青霉素、红霉素耐药率>80%,对克林霉素、氨苄西林、头孢唑啉的耐药率均>60%。革兰阴性菌对美罗培南敏感,对头孢他啶、头孢哌酮耐药率较低,对氨苄西林、哌拉西林、头孢噻肟耐药率较高。结论新生儿早发型及晚发型败血症的临床特点及常见病原菌不同,治疗时应合理应用抗生素类药物,加强耐药性监测。
Objective To investigate the distribution and drug resistance of neonatal sepsis pathogens. Methods 268 children with blood culture-positive sepsis admitted to Tongliao City Hospital of Inner Mongolia from 2010 to 2015 were divided into early-onset and late-onset group, and their clinical characteristics, pathogen distribution and drug resistance were analyzed. Results The main pathogens of early-onset septicemia were gram-negative bacteria (58.3%), including Escherichia coli (31.2%) and Klebsiella pneumoniae (23.9%). Gram-positive bacteria were the main pathogens of late-onset sepsis (65.1%), including coagulase-negative staphylococci (46.5%) and Enterococcus faecium (11.6%). Gram-positive bacteria were sensitive to vancomycin, resistant to penicillin and erythromycin> 80%, resistant to clindamycin, ampicillin and cefazolin> 60%. Gram-negative bacteria were sensitive to meropenem and had lower resistance rate to ceftazidime and cefoperazone, and higher rates to ampicillin, piperacillin and cefotaxime. Conclusion Neonatal early onset and late onset sepsis clinical features and common pathogens are different, the treatment should be rational use of antibiotics to enhance drug resistance monitoring.