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目的了解本院近10年来新生儿败血症病原菌及其耐药性变迁,以指导临床用药。方法对1997年3月至2002年3月收治的新生儿败血症(第1组)血培养检出菌、药敏试验结果进行回顾性调查,并与2002年4月至2007年3月的调查结果(第2组)进行比较。结果10年来新生儿败血症血培养阳性的患儿296例,第1组155例,第2组141例,病原菌以革兰阳性细菌为主,近5年来凝固酶阴性葡萄球菌(CNS)感染率明显增加(χ2=14.15,P<0.01),金葡菌感染率显著下降(χ2=10.88,P<0.01),对青霉素、苯唑西林及红霉素有较高的耐药率,多重耐药较明显,耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)及耐甲氧西林的金葡菌(MRSA)感染增多,对万古霉素敏感性较高。革兰阴性杆菌对氨苄西林普遍耐药,对亚胺培南、氨曲南高度敏感,对氨基糖甙类、喹诺酮类及三代头孢菌素敏感性较高,但耐药菌株有增加的趋势。结论CNS是本院新生儿败血症最主要的病原菌,对青霉素等常用抗生素普遍耐药,多重耐药菌株增加,根据病原菌药敏结果合理使用抗生素,是有效抗感染和延缓耐药菌株产生的必要条件。
Objective To understand the pathogenesis of neonatal sepsis in our hospital in recent 10 years and the changes of its drug resistance to guide the clinical medication. Methods A retrospective study was conducted on the results of drug susceptibility testing of blood cultures of neonatal sepsis (group 1) from March 1997 to March 2002 and the results of the drug susceptibility test were retrospectively analyzed and compared with the results of the survey from April 2002 to March 2007 (Group 2) for comparison. Results In the past 10 years, there were 296 cases of blood culture positive neonatal sepsis in Group 1, 155 cases in Group 1 and 141 cases in Group 2. Gram-positive bacteria were the main pathogens in this group. The infection rate of coagulase-negative staphylococci (CNS) (Χ2 = 14.15, P <0.01). The infection rate of Staphylococcus aureus was significantly decreased (χ2 = 10.88, P <0.01). The infection rates of penicillin, oxacillin and erythromycin were higher, Clearly, methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) increased infection, higher susceptibility to vancomycin. Gram-negative bacilli are generally resistant to ampicillin, are highly sensitive to imipenem and aztreonam, and have a high sensitivity to aminoglycosides, quinolones and third-generation cephalosporins, but resistant strains have an increasing trend. Conclusions CNS is the most important pathogen of neonatal sepsis in our hospital. It is generally resistant to common antibiotics such as penicillin, and multi-drug resistant strains are increased. The rational use of antibiotics according to drug susceptibility results of pathogens is a necessary condition for effective anti-infective and delayed drug-resistant strains .