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目的探讨新生儿重症监护室(NICU)血培养阳性败血症患儿主要临床特点、病原菌分布及耐药情况,为经验性使用抗生素及降低耐药菌株产生提供参考。方法对我院NICU 2011年10月至2012年10月收治的227例血培养阳性并且诊断为败血症新生儿临床资料进行回顾性分析。结果血培养阳性并且诊断为败血症者占总收治的3.44%,227例中出生胎龄≥37周126例,出生胎龄33~36+6周40例,出生胎龄≤32+6周61例;发病时以反应差、黄疸、呼吸暂停、发热或体温不升、皮肤淤斑/点、纳差多见。共培养出病原菌32种,革兰阳性菌139株,其中凝固酶阴性葡萄球菌94株,金黄色葡萄球菌9株;革兰阴性菌74例,肺炎克雷白杆菌29株,大肠埃希菌12株;真菌14株,以早产儿院内感染为主。革兰阳性菌对万古霉素、替加环素、利奈唑胺敏感,对呋喃妥因、利福平、喹奴普汀敏感性高,对青霉素、苯唑西林耐药性达90%以上,对红霉素耐药率达80%以上;鲍曼不动杆菌对除丁胺卡那外的常使用抗生素耐药率均较高,其余革兰阴性菌对丁胺卡那、哌拉西林/他唑巴坦、亚胺培南、头孢替坦敏感性均较高,真菌对常用抗真菌药物普遍敏感。结论新生儿败血症临床特征缺乏特异性,且不同胎龄新生儿败血症发病时间及主要临床表现不同;凝固酶阴性葡萄球菌、肺炎克雷白杆菌、大肠埃希菌仍是NICU中新生儿败血症主要的病原菌,耐药性普遍,临床医生应合理选用抗生素,减少耐药菌株产生。
Objective To investigate the main clinical features, pathogens distribution and drug resistance in neonates with intensive care unit (NICU) blood culture positive sepsis, and to provide reference for the empirical use of antibiotics and the reduction of resistant strains. Methods A retrospective analysis was performed on the clinical data of 227 neonates with positive blood culture diagnosed as septicemia from NICU from October 2011 to October 2012 in our hospital. Results Blood culture positive and diagnosed as sepsis accounted for 3.44% of the total, in 227 cases of gestational age ≥37 weeks in 126 cases, gestational age 33 ~ 36 + 6 weeks in 40 cases, gestational age ≤ 32 + 6 weeks in 61 cases ; When the onset of poor response, jaundice, apnea, fever or body temperature does not rise, eczema / point, anorexia more common. There were 32 pathogens and 139 Gram-positive bacteria, of which 94 were coagulase-negative staphylococci and 9 were Staphylococcus aureus; 74 were Gram-negative bacteria, 29 were Klebsiella pneumoniae and 12 were Escherichia coli 12 Strain; Fungus 14, mainly to premature nosocomial infections. Gram-positive bacteria are sensitive to vancomycin, tigecycline and linezolid, have high sensitivity to nitrofurantoin, rifampicin and quinuptine, and have a resistance to penicillin and oxacillin of over 90% The rate of resistance to the antibiotics was over 80%. Acinetobacter baumannii had a high rate of resistance to antibiotics other than amikacin. The other Gram-negative bacteria were resistant to amikacin, piperacillin / Batan, imipenem, cefotetan are higher sensitivity, fungi commonly used antifungal drugs are generally sensitive. Conclusions The clinical features of neonatal sepsis are not specific, and the onset time and main clinical manifestations of sepsis in different gestational age neonates are different. Coagulase-negative staphylococci, Klebsiella pneumonia, and Escherichia coli are still the main neonatal sepsis in NICU Pathogenic bacteria, drug resistance is common, clinicians should rational use of antibiotics, reduce drug-resistant strains.