论文部分内容阅读
目的 探讨新生儿重症监护病房(neonatal intensive care unit,NICU)早期新生儿肠道细菌定植影响因素及抗生素耐药性.方法 本研究为前瞻性队列研究,对2014年5月至2015年5月采集自北京妇产医院NICU住院新生儿生后第5～7天的粪便进行培养,采用VITEK-2系统进行细菌鉴定和抗生素敏感性检测,根据胎龄、分娩方式和是否使用抗生素将新生儿分为8组,比较各组大肠埃希菌、肠球菌和肺炎克雷伯菌定植率的差异.结果 共收集了572例新生儿的粪便,分离出大肠埃希菌328株、肠球菌243株、肺炎克雷伯菌70株,大肠埃希菌和肠球菌的多重耐药率分别为68.3％(136/199)和76.1％(185/243).足月顺产无抗生素组(77例)、足月剖宫产无抗生素组(30例)、早产剖宫产无抗生素组(28例)、早产顺产无抗生素组(16例)、早产顺产抗生素组(53例)、足月顺产抗生素组(155例)、足月剖宫产抗生素组(99例)、早产剖宫产抗生素组(114例)大肠埃希菌定植率为别为85.7％、66.7％、64.3％、62.5％、60.4％、56.1％、46.5％、43.0％,肠球菌定植率分别为20.8％、33.3％、28.6％、31.3％、47.2％、45.2％、52.5％、50.0％,肺炎克雷伯菌定植率分别为18.2％、13.3％、10.7％、12.5％、20.8％、9.7％、11.1％、8.8％.同胎龄同分娩方式抗生素组与无抗生素组比较、足月剖宫产无抗生素组与足月顺产无抗生素组比较,大肠埃希菌定植率明显下降,肠球菌定植率明显升高(P＜0.05);各组肺炎克雷伯菌定植率差异无统计学意义(P＞0.05).结论 早期新生儿肠道定植的大肠埃希菌和肠球菌多重耐药严重,细菌定植受抗生素和分娩方式的影响,临床需合理使用抗生素.“,”Objective To study the risk factors of intestinal bacteria colonization and antibiotic resistance among newborns in neonatal intensive care unit (NICU).Method From May 2014 to May 2015,newborns admitted to NICU in our hospital were enrolled and their feces were prospectively collected and cultured from day 5 to day 7 after birth.VITEK-2 system was used to identify the bacteria and determine their antibiotic susceptibility.Newborns were assigned into 8 groups according to their gestational age,mode of delivery and use of antibiotics,and the colonization rates of Escherichia coli (E.coli),Enterococcus and Klebsiella pneumoniae were compared.Result A total of 572 feces of newborns were collected,328 strains of E.coli,243 strains of Enterococcus and 70 strains of Klebsiella pneumoniae were isolated.The multi-drug resistance rates of E.coli and Enterococcus were 68.3％ (136/199) and 76.1％ (185/243),respectively.The colonization rates of E.coli,Enterococcus and Klebsiella pneumoniae of the full-term delivery without antibiotics group (77 cases),full-term Cesarean section (C-section) without antibiotics group (30 cases),premature C-section without antibiotics group (28 cases),premature delivery without antibiotics group (16 cases),premature delivery with antibiotics group (53 cases),full-term delivery with antibiotics group (155 cases),full-term C-section with antibiotics group (99 cases),premature C-section with antibiotics group (114 cases) were different.The antibiotics groups showed significantly less E.coli colonization rates and higher Enterococcus colonization rates than the non-antibiotics groups of the same gestational age and delivery mode (P ＜ 0.05).The result between the full-term C-section newborns and naturally delivered newborns without antibiotics indicated the similar trend (P ＜ 0.05).The colonization rates of Klebsiella pneumoniae showed no significant differences among the groups (P ＞ 0.05).Conclusion The multi-drug resistance of E.coli and Enterococcus in neonatal intestinal colonization is common and worrisome.Bacterial colonization is affected by antibiotics and the mode of delivery and prudent use of antibiotics is advised.