 |
 |
医学免费论文:新生儿败血症社区感染和院内感染的病原菌分析
【摘要】 目的 探讨本院新生儿败血症社区感染和院内感染的病原菌及药敏特点,以指导临床早期用药。方法 回顾分析近10年本院新生儿科收治的新生儿败血症246例，分为社区感染组和院内感染组，并对其病原菌及药敏结果进行分析。结果 社区感染早发组病原菌以凝固酶阴性葡萄球菌（CNS)、大肠埃希菌为主，晚发组以CNS、金黄色葡萄球菌为主。院内感染早发组和晚发组病原菌均以肺炎克雷伯菌为主。葡萄球菌属对青霉素、半合成青霉素、一代头孢菌素、红霉素耐药, 对二代头孢菌素部分敏感, 对利福平高度敏感, 对万古霉素敏感率为100%。产超广谱β内酰胺酶（ESBLS)革兰阴性菌对氨苄青霉素、一代头孢菌素、三代头孢菌素耐药, 对加酶抑制剂部分敏感, 对哌拉西林他唑巴坦高度敏感, 对碳青霉烯类敏感率为100%。结论 社区感染早发型经验性选择抗生素应兼顾革兰阴性菌和革兰阳性菌，晚发型应选择主要针对葡萄球菌的抗生素；对院内感染，无论早发型还是晚发型均应选择加酶抗生素，以哌拉西林他唑巴坦为首选。根据病情、病原菌及药敏结果合理选用药物，加强消毒隔离，避免交叉感染，能减缓细菌耐药性的增长。
【关键词】 败血症；新生儿；社区获得性感染；院内感染；抗药性；细菌
Analysis of the pathogens responsible for community-acquired and
hospital-acquired neonatal septicemia医.学.全.在.线www.lindalemus.com
DING Xian, CHEN Canhua, YANG Juan
(Department of Pediatrics, Affiliated Huai′an Hospital of Xuzhou Medical College, Huai′an, Jiangsu 223002, China)
Abstract： Objective To investigate the pathogens responsible for community-acquired and hospital-acquired neonatal septicemia and the antibiotic susceptibility characteristics of the pathogenic bacteria in order to provide guidance on early clinical medication. Methods A retrospective analysis was conducted on 246 cases of neonatal septicemia that were admitted to the neonatal section of our hospital during the past 10 years. The cases were divided into community-acquired infection groups and hospital-acquired infection groups according to the onset, and their pathogenic bacteria and drug susceptibility results were analyzed. Results The bacteria in the community-acquired infection early-onset group were mainly coagulase-negative staphylococcus (CNS) and Escherichia coli, and the pathogens in the late-onset group primarily consisted of CNS and Staphylococcus aureus; while in the hospital-acquired infection (early and late onset) groups, Klebsiella pneumoniae was predominant. Staphylococcus was resistant to penicillin, semi-synthetic penicillin, first-generation cephalosporins and erythromycin. It was susceptible only to certain second-generation cephalosporins, highly susceptible to rifampin, and its vancomycin-susceptibility rate was 100%. Extended spectrum β-lactamases (ESBLS) producing Gram-negative bacteria were resistant to ampicillin as well as the first-generation and third-generation cephalosporins. They were susceptible to certain beta-lactamase inhibitors and highly susceptible to piperacillin-tazobactam, and had 100% susceptibility to carbapenems. Conclusions In the treatment of community-acquired infections, empirical selection of antibiotics should be directed to both Gram-negative bacteria and Gram-positive bacteria in the early-onset infections, while in the late onset, antibiotics against Staphylococcus should be the major selection. In the hospital-acquired infections, regardless of early onset or late onset, beta-lactamase inhibitors should be selected, with piperacillin-tazobactam on the top priority. Reasonable choice of drugs should be based on the disease, pathogenic bacteria and drug susceptibility results and preventive use as indicated. Strengthened disinfection and isolation to prevent cross-infection can reduce the growth of bacterial resistance to drugs.
Key words： septicemia; neonatal; community-acquired infection; hospital-acquired infection; drug resistance; bacteria
英文已换新生儿败血症临床表现无特异性，但后果极其严重，应及早认识，做出诊断性评估，并迅速给予有效抗生素治疗，以提高治愈率［1］ 。我们将本院新生儿科近10年来收治的血培养阳性的新生儿败血症246例分为社区感染组和院内感染组，并对其病原菌及药敏结果作对比分析，以指导临床。
