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目的分析新生儿重症监护病房(NICU)医院感染常见的革兰阴性杆菌分布及耐药情况,为合理使用抗生素提供依据。方法采集2014年1月-2016年6月本院NICU中1 221例疑患感染性疾病新生儿的2 133份痰、血液、尿等标本,进行细菌培养和分离,用K-B法或仪器自动匹配系统分析致病菌及对抗菌素的耐药性。结果 2 133分标本中共分离革兰阴性杆菌235株,占所检出细菌的56.5%(235/416),位列前5的依次为大肠埃希菌(29.8%)、肺炎克雷伯菌(28.9%)、铜绿假单胞菌(13.2%)、鲍曼不动杆菌(6.1%)和嗜麦芽窄食单胞菌(5.9%)。肺炎克雷伯菌和大肠埃希菌的产超广谱β-内酰胺酶(ESBLs)率分别为45.7%(32/70)和39.7%(27/68),对氨曲南、头孢吡肟、头孢曲松、头孢噻肟、妥布霉素和氨苄青霉素均有较高的耐药率(53.1%~100%),但对加酶抑制剂的抗菌素耐药率低,未发现对碳青霉烯类药物耐药的菌株。铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌对亚胺培南的耐药率分别为16.1%、21.4%、100%。此外,所检出的革兰阴性杆菌对环丙沙星、左氧氟沙星均保持较低的耐药率(<20%)。结论革兰阴性杆菌是本院NICU的主要流行菌,定期进行细菌分布和耐药性监测,可为临床经验用药提供依据,有助于减少耐药菌株的产生。
Objective To analyze the distribution and drug resistance of Gram-negative bacilli in nosocomial neonatal intensive care unit (NICU), so as to provide basis for rational use of antibiotics. Methods A total of 2 221 samples of sputum, blood and urine from 1 221 newborns with suspected infectious diseases in the NICU of our hospital from January 2014 to June 2016 were collected for bacterial culture and separation, and were automatically matched by KB method or instrument System analysis of pathogens and antibiotic resistance. Results A total of 235 strains of gram-negative bacilli were isolated from 2 133 samples, accounting for 56.5% (235/416) of the detected bacteria. The top 5 bacteria were Escherichia coli (29.8%), Klebsiella pneumoniae 28.9%), Pseudomonas aeruginosa (13.2%), Acinetobacter baumannii (6.1%) and Stenotrophomonas maltophilia (5.9%). The ESBLs production rates of Klebsiella pneumoniae and Escherichia coli were 45.7% (32/70) and 39.7% (27/68), respectively. The rates of ESBLs to aztreonam, cefepime , Ceftriaxone, cefotaxime, tobramycin and ampicillin have a higher resistance rate (53.1% ~ 100%), but for the enzyme inhibitors with low antibiotic resistance rate, no discovery of carbon green Mycotoxins resistant strains. The resistance rates of Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia to imipenem were 16.1%, 21.4% and 100%, respectively. In addition, Gram-negative bacilli were detected to ciprofloxacin, levofloxacin maintained low resistance (<20%). Conclusions Gram-negative bacilli are the main epidemic bacteria of NICU in our hospital. Regular bacterial distribution and drug resistance monitoring can provide basis for clinical experience and help reduce the generation of drug-resistant strains.