摘要
目的分析新生儿重症监护病房(NICU)住院患儿多重耐药菌的定植状况以及耐药特点,为预防和控制多重耐药菌在院内的传播及临床合理用药提供科学依据。方法对2018年5月1日至10月31日期间在广西壮族自治区妇幼保健院NICU住院患儿176例,入院1 h内采集肛拭子进行定植菌筛查。筛查阳性者,进行耐药性分析,了解NICU住院患儿细菌定植及耐药情况。采用χ2检验比较不同分娩方式患儿中细菌培养结果及不同日龄患儿细菌分离率的差异。结果在23例患儿标本中检测出多重耐药菌,多重耐药菌定植率13.1%(23/176),日龄<3 d新生儿多重耐药菌筛查阳性率低于日龄3~28 d的新生儿,差异具有统计学意义(χ^2=4.099,P=0.043)。其中23株多重耐药细菌包括:11株产超广谱β-内酰胺酶(ESBLs)肠杆菌,10株耐万古霉素肠球菌(VRE),2株耐甲氧西林金黄色葡萄球菌(MRSA)。11株产ESBLs肠杆菌对氨苄西林、哌拉西林、头孢唑啉、头孢呋辛、头孢曲松、庆大霉素耐药率达100%;10株VRE对万古霉素、青霉素、氨苄西林耐药率达100%,对替考拉宁和利奈唑胺完全敏感。2株MRSA除对万古霉素、替考拉宁和利奈唑胺完全敏感,对青霉素类、头孢菌素类、红霉素完全耐药。结论NICU住院患儿肠道多重耐药菌定植情况比较严重,以产ESBLs肠杆菌、VRE为主,耐药现象严重。应重视日龄≥3 d新生儿肛拭子多重耐药菌的筛查,加强监测,避免多重耐药菌在医院内暴发流行。
Objective To provide a scientific basis for the prevention and control of the spread of multidrug-resistant bacteria in hospital and the rational clinical use of drugs by investigating and analyzing the colonization status and drug resistance characteristics of multidrug-resistant bacteria in the neonatal intensive care unit(NICU).Methods Bacterial culture and drug sensitivity test were carried out on 176 anal swabs in NICU hospitalized patients at Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital from May 1 to October 312018.Swabs were collected within one hour of admission for sterile screening.Drug resistance analysis was carried out on patients whose screening result was positive,to know bacterial colonization and resistance in patients admitted to the NICU.The results of bacterial culture and the rate of bacterial isolation in children of different ages were compared by theχ2 test.Results Multiple drug-resistant bacteria were detected in 23 children's specimens,and the colonization rate of multidrug-resistant bacteria was 13.1%.The positive rate of multiple drug-resistant bacteria in newborns<3 d was lower than that of newborns 3~28 d(χ^2=4.099,P=0.043).Of the 23 strains of multidrug-resistant bacteria detected,11 were extended-spectrumβlactamases(ESBLs)-producing bacteria,10 were vancomycin-resistant Enterococcus(VRE),and 2 were methicillin-resistant Staphylococcus aureus(MRSA).The resistance rate of 11 strains of ESBLs-producing bacteria to ampicillin,piperazine,cefazolin,cefuroxime,ceftriaxone,and gentamicin was 100%.The resistance rate of 10 strains of VRE to vancomycin,penicillin,and ampicillin was also 100%,while they were completely sensitive to tekelanin and linezolid.The two strains of MRSA were completely sensitive to vancomycin,tekelanin,and linezolid,but were completely resistant to penicillin,cephalosporins,and erythromycin.Conclusion The colonization rate of multidrug-resistant bacteria is high among children in NICU and the drug resistance is serious.Attention should be pa
作者
李燕
姚丽平
姚家艳
Li Yan;Yao Liping;Yao Jiayan(Newborn Department,Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital,Nanning 530003,China)
出处
《中华临床医师杂志（电子版）》
CAS
2019年第10期754-757,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
新生儿重症监护病房
多重耐药菌
细菌定植
耐药性分析
Neonatal intensive care unit
Multiple drug-resistant bacteria
Bacterial colonization
Drug resistance
