| 摘要: |
| 目的：探讨新生儿产超广谱β-内酰胺酶菌（ESBLs）感染的临床表现及耐药性，为临床用药提供参考。方法：选取2013年8月至2014年8月我院疑似细菌感染新生儿132例作为研究对象，取患儿咽拭子、痰液及大便进行检验，标本进行分离培养、药敏试验，对产ESBLs菌阳性新生儿的临床表现及产ESBLs菌耐药性进行分析。结果：住院新生儿入院24 h经咽拭子、痰液及大便共检出30株病原菌，ESBLs菌检出率为11.90%；入院72 h后经咽拭子、痰液及大便共检出145株病原菌，产ESBLs菌检出率为53.90%，显著高于入院当天的检出率，差异有统计学意义（χ2=102.833，P<0.05）。ESBLs阳性菌对碳青霉烯类、β-内酰胺酶抑制剂复合物抗生素敏感，对头孢噻肟、头孢他啶、头孢曲松、头孢吡肟、头孢唑林、替卡西林和环丙沙星明显耐药，耐药率高于ESBLs阴性菌，差异有统计学意义（χ2分别为34.462、35.559、53.829、41.738、29.796、39.602、34.462，P均<0.01)。ESBLs阴性菌对碳青霉烯类、β-内酰胺酶抑制剂复合物抗生素、妥布霉素较为敏感。ESBLs阳性菌和ESBLs阴性菌对碳青霉烯类、β-内酰胺酶抑制剂复合物抗生素的耐药率均较低。结论：临床应重视对产ESBLs菌感染的监测，合理选用抗生素治疗，治疗产ESBLs菌所致的新生儿严重院内感染，可选用碳青霉烯类、β-内酰胺酶抑制剂复合物抗生素治疗。 |
| 关键词: 新生儿 超广谱β-内酰胺酶 抗生素 耐药性 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.06.013 |
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| 基金项目: |
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| Clinical Manifestations and Drug Resistance Analysis of Extended-spectrum Beta-lactamase Bacteria Neonatal Infection |
| Zhang Rui, Yang Lin, Xiao Yu, Li Tao |
| (Shiyan Taihe Hospital Affiliated to Hubei Medical College, Hubei Shiyan 442000, China) |
| Abstract: |
| Objective: It discussed the clinical manifestations and drug resistance of extended-spectrum beta-lactamase bacteria (ESBLs) neonatal infection to provide guidance for clinic. Methods: 132 cases of newborn with suspected bacterial infection were selected as research objects in our hospital from August, 2013 to August 2014. Throat swab, sputum and defecate were tested, and then isolated culture and drug sensitive tests were adopted on those specimens to give analysis on clinical manifestations and drug resistance of ESBLs bacteria positive newborns. Results: 30 strains of pathogenic bacteria were detected through throat swab ,sputum and defecate from those newborns at 24 hours after admission, and the ESBLs bacteria detection rate was 11.90%, while 145 strains of pathogenic bacteria were detected through throat swab, sputum and defecate after admission of 72 hours, and the ESBLs bacteria detection rate was 53.90% which was significantly higher than that of the day of admission. The difference was statistically significant (χ2=102.833, P<0.05). ESBLs positive bacteria were sensitive to carbapenems and beta lactamase inhibitor compound antibiotics and had strong drug resistance on cefotaxime, ceftazidime, ceftriaxone, cefepime, cefazolin, ticarcilin and ciprofloxacin. The durg reisitance was higher than that of ESBLs negative bacteria which had statistical significance (χ2 was 34.462, 35.559, 53.829, 41.738, 29.796, 39.602, 34.462, P<0.01 for all). ESBLs negative bacteria were very sensitive to carbapenems, beta lactamase inhibitor compound antibiotics and tobramycin and had low drug resistance on them. Conclusion: Clinic should pay attention to detection on ESBLs bacterial infections and choose antibiotics treatment reasonably. Carbapenems treatment and beta lactamase inhibitor compound antibiotics treatment could be chose to treat neonatal severe infection of ESBLs. |
| Key words: neonatal extended-spectrum beta-lactamase antibiotic drug resistance |
