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醫(yī)學(xué)免費(fèi)論文:新生兒敗血癥社區(qū)感染和院內(nèi)感染的病原菌分析
【摘要】 目的 探討本院新生兒敗血癥社區(qū)感染和院內(nèi)感染的病原菌及藥敏特點(diǎn),以指導(dǎo)臨床早期用藥。方法 回顧分析近10年本院新生兒科收治的新生兒敗血癥246例，分為社區(qū)感染組和院內(nèi)感染組，并對(duì)其病原菌及藥敏結(jié)果進(jìn)行分析。結(jié)果 社區(qū)感染早發(fā)組病原菌以凝固酶陰性葡萄球菌（CNS)、大腸埃希菌為主，晚發(fā)組以CNS、金黃色葡萄球菌為主。院內(nèi)感染早發(fā)組和晚發(fā)組病原菌均以肺炎克雷伯菌為主。葡萄球菌屬對(duì)青霉素、半合成青霉素、一代頭孢菌素、紅霉素耐藥, 對(duì)二代頭孢菌素部分敏感, 對(duì)利福平高度敏感, 對(duì)萬(wàn)古霉素敏感率為100%。產(chǎn)超廣譜β內(nèi)酰胺酶（ESBLS)革蘭陰性菌對(duì)氨芐青霉素、一代頭孢菌素、三代頭孢菌素耐藥, 對(duì)加酶抑制劑部分敏感, 對(duì)哌拉西林他唑巴坦高度敏感, 對(duì)碳青霉烯類(lèi)敏感率為100%。結(jié)論 社區(qū)感染早發(fā)型經(jīng)驗(yàn)性選擇抗生素應(yīng)兼顧革蘭陰性菌和革蘭陽(yáng)性菌，晚發(fā)型應(yīng)選擇主要針對(duì)葡萄球菌的抗生素；對(duì)院內(nèi)感染，無(wú)論早發(fā)型還是晚發(fā)型均應(yīng)選擇加酶抗生素，以哌拉西林他唑巴坦為首選。根據(jù)病情、病原菌及藥敏結(jié)果合理選用藥物，加強(qiáng)消毒隔離，避免交叉感染，能減緩細(xì)菌耐藥性的增長(zhǎng)。
【關(guān)鍵詞】 敗血癥；新生兒；社區(qū)獲得性感染；院內(nèi)感染；抗藥性；細(xì)菌
Analysis of the pathogens responsible for community-acquired and
hospital-acquired neonatal septicemia醫(yī).學(xué).全.在.線zxtf.net.cn
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
英文已換新生兒敗血癥臨床表現(xiàn)無(wú)特異性，但后果極其嚴(yán)重，應(yīng)及早認(rèn)識(shí)，做出診斷性評(píng)估，并迅速給予有效抗生素治療，以提高治愈率［1］ 。我們將本院新生兒科近10年來(lái)收治的血培養(yǎng)陽(yáng)性的新生兒敗血癥246例分為社區(qū)感染組和院內(nèi)感染組，并對(duì)其病原菌及藥敏結(jié)果作對(duì)比分析，以指導(dǎo)臨床。
