Patel Dipen, Nimbalkar Archana, Sethi Ankur, Kungwani Amit, Nimbalkar Somashekhar
Department of Pediatrics, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, 388325, India.
Indian J Pediatr. 2014 Aug;81(8):785-90. doi: 10.1007/s12098-013-1314-2. Epub 2014 Jan 11.
To study prevalent organisms in neonatal sepsis, their sensitivity to antibiotics and outcome in neonates with culture proven sepsis.
This was a retrospective study of hospital records of 4 y. From 276 culture positive reports of 226 newborns, organisms, their sensitivity to different antibiotics were studied and their outcome was compared to 571 culture negative newborns. Growth detection was done by BacT/ALERT®PF system.
Most common isolates were Klebsiella (42.4 %), Coagulase-negative staphylococci (11.2 %), Enterobacter (9.4 %), Escherichia coli (9.1 %), Pseudomonas (5.4 %) and Acinetobacter (4.7 %). Gram negative organisms were predominant both in early-onset and late-onset neonatal sepsis as well as in inborn and outborn newborns and most of them were resistant to commonly used first line antibiotics like ampicillin, gentamicin and cephalosporins. Extended Spectrum Beta Lactamase producing Klebsiella and Escherichia coli were 94.87 % and 92 %, respectively. Methicillin resistant Staphylococci were 33 %. Vancomycin resistance among the Enterococci was 20 %. Most effective first line antibiotic combinations were amikacin with levofloxacin and amikacin with piperacillin-tazobactam. Survival in culture positive newborns (43.36 %, 95 % CI 37.07 to 49.88) was poor than culture negative newborns (53.06 %, 95 % CI 48.96 to 57.12).
Gram negative organisms were most common cause of neonatal sepsis and were resistant to first line antibiotics. Blood culture positive newborns had poor outcome than culture negative newborns.
研究新生儿败血症中的常见病原体、它们对抗生素的敏感性以及血培养确诊败血症新生儿的转归情况。
这是一项对4年医院记录的回顾性研究。从226例新生儿的276份血培养阳性报告中，研究病原体及其对不同抗生素的敏感性，并将其转归情况与571例血培养阴性的新生儿进行比较。采用BacT/ALERT®PF系统进行生长检测。
最常见的分离菌为克雷伯菌（42.4%）、凝固酶阴性葡萄球菌（11.2%）、肠杆菌（9.4%）、大肠杆菌（9.1%）、铜绿假单胞菌（5.4%）和不动杆菌（4.7%）。革兰阴性菌在早发型和晚发型新生儿败血症中均占主导，在院内出生和院外出生的新生儿中也是如此，并且它们中的大多数对常用的一线抗生素如氨苄西林、庆大霉素和头孢菌素耐药。产超广谱β-内酰胺酶的克雷伯菌和大肠杆菌分别为94.87%和92%。耐甲氧西林葡萄球菌为33%。肠球菌对万古霉素的耐药率为20%。最有效的一线抗生素组合是阿米卡星与左氧氟沙星以及阿米卡星与哌拉西林-他唑巴坦。血培养阳性新生儿的生存率（43.36%，95%可信区间37.07至49.88）低于血培养阴性新生儿（53.06%，95%可信区间48.96至57.12）。
革兰阴性菌是新生儿败血症最常见的病因，并且对一线抗生素耐药。血培养阳性的新生儿比血培养阴性的新生儿转归更差。
