新生儿重症监护室医院感染流行菌及耐药率分析

目的了解本院新生儿重症监护室（NICU）医院感染病原菌的分布和耐药情况，为NICU合理运用抗生素提供依据。方法2006年7月-2008年6月对本院新生儿重症监护室2411份临床标本进行细菌培养鉴定和药敏试验，并对结果进行统计分析。结果共检出病原菌285株。革兰阴性菌170株，以肺炎克雷伯菌最多（62株），产超广谱β-内酰胺酶（ESBLs）率高（79．0％）。对碳青霉烯和喹诺酮类耐药率显著低于青霉素类、氨基糖苷类和头孢菌素类。革兰阳性菌88株，以凝固酶阴性葡萄球菌（CNS）最多（61株），金黄色葡萄球菌其次（12株），耐甲氧西林凝固酶阴性葡萄球菌（MRSCN）和耐甲氧西林金黄色葡萄球菌（MRSA）检出率高（83．3％和93．4％）。对力奈唑烷、万古霉素、呋喃妥因完全敏感，对青霉素类、大环内酯类和林可霉素类耐药率较高。结论本院NICU感染病原菌以革兰阴性菌为主。产ESBLs革兰阴性菌、MRSCN、MRSA的高检出率以及耐万古霉素肠球菌（VRE）的检出提示多重耐药现象严重。

Analysis of Bacterial Strains of Nosocomial Infection and Drug Resistance in Neonatal Intensive Care Unit

Objective To investigate the distribution and drug resistance of pathogenic bacteria of nosocomial infection in neonatal intensive care unit （NICU） and provide evidence for the rational use of antibiotics. Methods Bacterial culture, identification and drug sensitivity test were carried out with the total of 2411 specimens, collected from NICU between July 2006 and June 2008. Results In 2411 specimens, a total of 285 strains were isolated, among which 170 were Gram-negative bacilli, 62 strains of which were Klebsiena pneumonia with 79.0% of extended- spectrum β-lactamases （ESBLs）. The resistance rates of carbapenems and quinolones were significantly lower than those of penicinins, cephalosporins and aminoglycoside. A total of 88 strains were Gram-positive bacilli, among which the majority were coagulase-negative staphylococci （CNS, 61 strains）, followed by Staphylococcus aurous （SA, 12 strains）. The positive rates of methicillin-resistant coagulase-negative staphylococci （MRSCN） and Staphylococcus aurous （MRSA） were 83.3% and 93.4%, respectively. All of CNS and SA were sensitive to linezolid, vancomycin and nitrofurantoin, but had high resistance rates of penicillins, macrolides, lincomycin. Conclusion Gram-negative bacilli are the major pathogens that cause neonatal nosoeomial infections in NICU of our hospital. The high positive rates of ESBL-produced Gram-negative bacilli, MRSCN, MRSA and vancomycin-resistance enterococcus （VRE） indicate the serious problem of muhidrug resistance. Pipcracillin/tazobactam, cefoperazone/ sulbactam and carbapcnems can be the first choice of empirical antibiotic treatment for severe neonatal nosocomial infections. Antibiotic therapy should be adjusted under the guidance of drug sensitivity test.