摘要
目的分析耐碳青霉烯类革兰阴性菌新生儿败血症的病原菌分布及抗菌药物的使用,为临床合理使用抗菌药物提供理论依据。方法回顾性分析复旦大学附属儿科医院新生儿重症监护病房(Neonatal intensive care unit,NICU)2013年1月-2017年12月血及脑脊液培养确诊为耐碳青霉烯类革兰阴性菌败血症新生儿的临床资料及抗菌药物使用情况。结果共收集血及脑脊液培养阳性的耐碳青霉烯类革兰阴性菌59株,其中碳青霉烯类耐药肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae, CRKP)35株,耐碳青霉烯类鲍氏不动杆菌(Carbapenem-resistant Acinetobacter baumannii, CRAB)13株,耐碳青霉烯类阴沟肠杆菌(Carbapenem-resistant Enterobacter cloacae, CREC)4株;CRKP对阿米卡星、庆大霉素、左氧氟沙星敏感率较高,为100.00%;对磷霉素敏感率较高,为96.30%;但CRKP对头孢菌素类及β内酰胺类抗菌药物的敏感率较低;13例占23.64%患儿选用美罗培南和磷霉素联合治疗,9例占16.36%患儿选用美罗培南和氨苄西林钠舒巴坦钠联合治疗,6例占10.91%患儿使用美罗培南治疗,治愈率达到80.00%。结论美罗培南联合磷霉素可用于血培养耐碳青霉烯类革兰阴性菌败血症新生儿的治疗,临床医生应结合实验室药敏结果、临床疗效及最小抑菌浓度(Minimal inhibitory concentration, MIC)值合理使用抗菌药物,以减少或延缓耐碳青霉烯类细菌的产生。
OBJECTIVE To analyze the pathogen distribution and antibiotic usage in neonatal septicemia with carbapenem-resistant Gram-negative bacteria, and to provide a theoretical basis for rational use of antibiotics. METHODS The clinical data and antibiotic use of neonates in neonatal intensive care unit of Children’s Hospital of Fudan University from Jan. 2013 to Dec. 2017 who were diagnosed with neonatal septicemia by blood and cerebrospinal fluid culture were analyzed. RESULTS Totally 59 strains of carbapenem-resistant Gram-negative bacteria positive in blood and cerebrospinal fluid culture were collected, including 35 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP), 13 strains of carbapenem-resistant Acinetobacter bauman(CRAB), 4 strains of carbapenem-resistant Enterobacter cloacae(CREC). The sensitivity of CRKP to amikacin, gentamicin and levofloxacin was 100.00%, and the resistance to fosfomycin was 96.30%. But CRKP showed low resistance to cephalosporins and beta-lactams. 13 cases(23.64%) were treated with meropenem and fosfomycin combined therapy, 9 cases(16.36%) were treated with ampicillin sodium and meropenem, 6 cases(10.91%) used meropenem in the treatment, and the overall cure rate reached 80%. CONCLUSION Meropenem combined with fosfomycin can be used in the treatment of neonatal septicemia with carbapenem-resistant Gram-negative bacteria diagnosed by blood culture, and clinicians should combine the drug sensitivity in the laboratory, the clinical efficacy and minimal inhibitory concentration(MIC) value of antibiotics to rationally use antibiotics, so as to reduce or delay the generation of carbapenem-resistant bacteria.
作者
李小霞
王燕
朱琳
李琴
朱逸清
卢金淼
张旭晖
王广飞
刘晓辰
李智平
LI Xiao-xia;WANG Yan;ZHU Lin;LI Qin;ZHU Yi-qing;LU Jin-miao;ZHANG Xu-hui;WANG Guang-fei;LIU Xiao-chen;LI Zhi-ping(Children’s Hospital of Fudan University,Shanghai 201102,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第16期2500-2504,共5页
Chinese Journal of Nosocomiology
基金
中国-世卫组织2016-2017双年度合作基金资助项目(2016/647672-0)
上海市卫生计生系统重要薄弱学科建设基金资助项目(2016ZB0305)
