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[新生儿败血症相关因素、细菌学特征及抗菌谱分析]

[An analysis of relative factors, bacteriological profile and antibiogram of neonatal sepsis].

作者信息

Chen T, Ma H J, Yang J, Liu W, Dai X T, Tong H

机构信息

Medical Research Center, the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2018 Oct 6;52(10):1023-1028. doi: 10.3760/cma.j.issn.0253-9624.2018.10.011.

Abstract

This study was designed to identify the relative factors, bacteriological profile and their antibiotic susceptibility pattern of neonatal sepsis. A retrospective survey was conducted on the clinical information, pathogen identification and antibiotic sensitivity results of 425 newborns with neonatal sepsis admitted to Nanjing Maternity and Child Health Care Hospital from 2010 to 2017. Of the 425 positive blood-cultures, 148 (34.82%) were early-onset neonatal sepsis (EOS) and 277 (65.18%) were late-onset neonatal sepsis (LOS). Clinical information and pathogen identification were compared between EOS and LOS. Antibiotic sensitivity of gram negative organisms (G(-)) and gram positive organisms (G(+)) were also detected. The rates of premature delivery (78.70%, 218), low birth weights (67.15%, 186) and cesarean delivery (59.57%, 165) were significantly increased in LOS (0.05) compared with those rates in EOS, which were 41.89% (62), 37.84% (56) and 46.62% (69). Parturients fever (18.24%, 27) and meconium like amniotic fluid (25.68%, 38) were significantly increased in EOS (0.05) compared with those rates in LOS, which were 7.94% (22) and 5.42% (15). Among the identified pathogen, the incidence of G(-) and G(+) bacteria were 216 (50.83%) and 201 (47.29%) respectively, and the rest was (1.88%, 8). 68 (16.00%) was the predominant isolate followed by (13.18%, 56). The detection rate of (10.81%, 16) was significantly increased in EOS (0.001) compared with LOS (1.44%, 4). However, the incidence of (5.88%, 44) was higher in LOS (0.024) compared with EOS (8.11%, 12). Most of the gram positive isolates exhibited high resistance to penicillin (90.32%-100.00%) and cephalosporin group antibiotics (25.00%-100.00%). Similarly, the majority of the gram negative isolates showed higher resistance to ampicillin (83.33%-100.00%), but susceptible to aminoglycosides (0-11.76%), quinolones (0-17.65%) and β-lactams (0-5.88%). Among the study population, the percent of preterm, low birth weight and cesarean section were higher in LOS while parturients fever and meconium-like amniotic fluid were higher in EOS. The pathogens with the highest detection rate were and . The results of antibiotic susceptibility test showed that common pathogens had high resistance to commonly used antibacterial drugs.

摘要

本研究旨在确定新生儿败血症的相关因素、细菌学特征及其抗生素敏感性模式。对2010年至2017年期间入住南京妇幼保健院的425例新生儿败血症患儿的临床信息、病原体鉴定及抗生素敏感性结果进行了回顾性调查。在425份血培养阳性样本中,148例(34.82%)为早发型新生儿败血症(EOS),277例(65.18%)为晚发型新生儿败血症(LOS)。比较了EOS和LOS之间的临床信息和病原体鉴定情况。还检测了革兰氏阴性菌(G(-))和革兰氏阳性菌(G(+))的抗生素敏感性。与EOS组相比,LOS组的早产率(78.70%,218例)、低出生体重率(67.15%,186例)和剖宫产率(59.57%,165例)显著升高(P<0.05),EOS组的早产率、低出生体重率和剖宫产率分别为41.89%(62例)、37.84%(56例)和46.62%(69例)。与LOS组相比,EOS组产妇发热率(18.24%,27例)和羊水粪染率(25.68%,38例)显著升高(P<0.05),LOS组的产妇发热率和羊水粪染率分别为7.94%(22例)和5.42%(15例)。在鉴定出的病原体中,G(-)菌和G(+)菌的发生率分别为216例(50.83%)和201例(47.29%),其余为8例(1.88%)。大肠埃希菌(16.00%,68例)是最主要的分离菌株,其次是肺炎克雷伯菌(13.18%,56例)。与LOS组(1.44%,4例)相比,EOS组大肠埃希菌的检出率显著升高(10.81% , P<0.001)。然而,与EOS组(8.11%,12例)相比,LOS组肺炎克雷伯菌的发生率更高(5.88%,44例),差异有统计学意义(P<0.024)。大多数革兰氏阳性分离菌株对青霉素(90.32%-100.00%)和头孢菌素类抗生素(25.00%-100.00%)表现出高度耐药。同样,大多数革兰氏阴性分离菌株对氨苄西林耐药率较高(83.33%-100.00%),但对氨基糖苷类(0-11.76%)、喹诺酮类(0-17.65%)和β-内酰胺类(0-5.8)敏感。在研究人群中,LOS组的早产、低出生体重和剖宫产比例较高,而EOS组的产妇发热和羊水粪染比例较高。检出率最高的病原体是大肠埃希菌和肺炎克雷伯菌。抗生素敏感性试验结果表明,常见病原体对常用抗菌药物具有较高的耐药性。

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