乌干达西部卡塞塞区基莱姆贝矿医院新生儿败血症的细菌学特征、抗生素敏感性及相关因素分析。
Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda.
机构信息
Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
Department of Medical Laboratory Science, Faculty of Health Sciences, Muni University, P.O. Box 725, Arua, Uganda.
出版信息
BMC Microbiol. 2021 Nov 4;21(1):303. doi: 10.1186/s12866-021-02367-z.
INTRODUCTION
Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths.
OBJECTIVE(S): To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates suspected to sepsis at Kilembe mines hospital.
METHODS
We conducted a descriptive cross-sectional study, where purposive sampling technique was used and blood was drawn from 122 neonates suspected to sepsis attending Kilembe Mines Hospital during the period (July to November 2020). Specimens were inoculated in Brain heart infusion broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by Gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Associations were tested using Chi square with Fisher's exact or Yates correction tests where necessary and statistical significance was set at P < 0.05. Stata (version 14) used for statistical analysis.
RESULTS
Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than Gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against Gram negative isolates. Risk factors of neonatal septicaemia were mother's age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500 g, Apgar score 1st and 5th min ≥6 and resuscitation.
CONCLUSION
Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.
引言
新生儿败血症是发展中国家导致新生儿发病率和死亡率的最常见主要原因之一。据估计，全球每年有超过 3000 万人受到影响，可能导致 600 万人死亡。
目的
确定基利姆贝矿医院疑似败血症新生儿败血症的患病率、细菌学特征、抗生素敏感性和相关因素。
方法
我们进行了一项描述性的横断面研究，使用了目的抽样技术，从 2020 年 7 月至 11 月期间在基利姆贝矿医院就诊的 122 名疑似败血症的新生儿中抽取血液。标本接种在脑心浸液肉汤中，运送到福波尔地区转诊医院，每天在血液、巧克力、麦康凯琼脂上划线，在有氧和 5%二氧化碳中孵育。通过革兰氏染色、生化试验和 Kirby Bauer 圆盘扩散法获得的抗生素敏感性对纯菌落进行鉴定。必要时使用卡方检验（Fisher 确切检验或 Yates 校正检验）检验关联，统计显著性设为 P<0.05。使用 Stata（版本 14）进行统计分析。
结果
血培养阳性率为 59.0%，其中男性占 55.5%，女性占 44.4%。EOS 占 56.9%，LOS 占 43.1%。革兰氏阴性（56.9%）病原体比革兰氏阳性病原体（43.1%）更易引起新生儿败血症。革兰氏阳性病原体对阿米卡星、利奈唑胺和万古霉素的敏感性较好，但对氨苄西林和庆大霉素的耐药性较强。在氨基糖苷类药物中，阿米卡星对革兰氏阴性分离株的疗效优于奈替米星和庆大霉素。新生儿败血症的危险因素包括母亲年龄≥25 岁、母亲就业、三级教育水平、SVD、ANC 就诊≥4 次、妊娠期间尿路感染、PROMS、恶露有臭味、城市居住、新生儿出生体重≥2500g、1 分钟和 5 分钟 Apgar 评分≥6 分以及复苏。
结论
分离出了多药耐药菌。因此，在选择抗生素治疗时需要谨慎，避免经验性治疗。
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