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目的探讨新生儿重症监护病房(NICU)医院感染常见病原菌的分布及耐药情况。方法采集该医院NICU中733例疑患感染性疾病新生儿的1 384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其对抗菌素的耐药性。结果 1 384份标本中共分离出病原菌264株,总阳性率为19.1%。革兰阴性杆菌141株(53.4%),主要为大肠埃希菌(15.5%),其次为肺炎克雷伯菌(11.7%)、铜绿假单胞菌(6.8%)、鲍曼不动杆菌(3.0%)和嗜麦芽窄食单胞菌(3.0%);产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌对头孢菌素和氨苄青霉素均有较高的耐药率(77.8%~100.0%),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16.7%、25.0%、100.0%。检出革兰阳性球菌121株(45.9%),以凝固酶阴性葡萄球菌占优势,其次为金黄色葡萄球菌和粪肠球菌;其中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和金黄色葡萄球菌(MRSA)分别占各自菌株的23.5%(12/51)和18.8%(6/32),革兰阳性球菌对利奈唑胺耐药率均较低(0.0%~16.7%),未发现有对万古霉素耐药的革兰阳性菌株。此外,环丙沙星、左氧氟沙星对革兰阳性球菌,尤其对革兰阴性杆菌的耐药率较低。结论凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌是本院NICU的主要流行病原菌,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,有助于减少细菌耐药。
Objective To investigate the distribution and drug resistance of common pathogens in hospital neonatal intensive care unit (NICU). The method of specimen collection in a hospital NICU 733 cases suspected of having an infectious disease of the newborn 1384 sputum, blood, urine, and bacterial cultures isolated KB automatic matching method or instrument system analysis and pathogen resistance to antibiotics Medicinal properties. Results A total of 264 pathogenic bacteria were isolated from 1 384 specimens and the total positive rate was 19.1%. 141 Gram-negative bacilli (53.4%) were mainly Escherichia coli (15.5%), followed by Klebsiella pneumoniae (11.7%), Pseudomonas aeruginosa (6.8%), Acinetobacter baumannii 3.0%) and Stenotrophomonas maltophilia (3.0%). Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) had higher levels of cephalosporin and ampicillin (77.8% -100.0%). However, the rate of antibiotic resistance to enzyme inhibitors was low and no strains resistant to carbapenems were found. The resistance rates of Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia to imipenem were 16.7%, 25.0% and 100.0%, respectively. 121 strains of Gram-positive cocci (45.9%) were detected with coagulase-negative Staphylococcus aureus predominating, followed by Staphylococcus aureus and Enterococcus faecalis. Methicillin-resistant coagulase-negative staphylococci (MRCNS) and golden yellow grape (MRSA) accounted for 23.5% (12/51) and 18.8% (6/32) of their respective strains, while the rate of resistance to linezolid in Gram-positive cocci was low (0.0% ~ 16.7%). Gram-positive strains resistant to vancomycin. In addition, ciprofloxacin, levofloxacin against Gram-positive cocci, especially for gram-negative bacilli lower resistance rate. Conclusion coagulase-negative staphylococci, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae is the predominant pathogen hospital NICU, regular distribution of bacteria and monitoring of drug resistance, may provide the basis for clinical experience of drug use, there is Helps reduce bacterial resistance.