中国西南地区1993-2014年新生儿败血症病原菌及其药敏变迁

发布时间：2018-06-07 20:06

本文选题：新生儿败血症 + 早发性败血症　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的新生儿败血症(Neonatal sepsis,NS)是新生儿时期严重的感染性疾病,具有较高的发病率和死亡率。NS病原菌及其药敏的分析在治疗及预防中起到重要的作用。明确其病原菌及其药敏有助于及时、合理的选用抗菌治疗,有效的降低NS的死亡率。而NS病原菌及药敏情况存在地区性及时间性差异。本课题旨在研究中国西南地区NS病原菌及其药敏的变迁。方法收集自1993年1月1日至2014年9月30日期间在重庆医科大学附属儿童医院新生儿诊治中心住院的共1245名NS患儿相关临床资料。回顾性分析所有患儿的一般信息、病原菌及其药敏的构成比及变迁。所有数据采用SPSS13.0版本进行统计分析和处理。结果本研究中共有596名患儿诊断为早发性败血症(early-onset sepsis, EOS),649名诊断为晚发型败血症(late-onset sepsis, LOS) o EOS主要的致病菌为葡萄球菌属(53.6%,n=339),其次为肠杆菌属(12.7%,n=80)及克雷伯氏菌属(7.1%,n=45); LOS最主要的致病菌仍是葡萄球菌属(50.8%,n=356),其次为肠杆菌(9.8%,n=69)、克雷伯氏菌(9.7%,n=68)以及真菌(7.4%,n=52)。在研究期间,对于EOS而言,其主要致病菌G+球菌的比例由71%下降至43%左右,位居第二位的G-杆菌则由14%上升至55%左右。与此同时,G+球菌中占绝大部分的葡萄球菌属的比例由65%降至37%左右。而作为G-杆菌的主要病原菌,肠杆菌属及克雷伯菌属分别由4%升至36%左右、2%升至15%左右。对于LOS而言,G-杆菌的比例由10%升至38%左右,而作为LOS的主要致病菌,G+球菌则由80%降至47%左右。其中,在G+球菌中所占虽多的葡萄球菌属的比例由68%降至35%左右,而G-杆菌中的肠杆菌属及克雷伯氏菌属分别由5%升至17%左右、2%升至18%左右。另外,我们发现真菌属在EOS中所占比例不高,仅为0.5%(n=3),但在LOS中所占比例高达7.4%(n=52),且其在LOS中的比例在2005-2014年期间由3%逐年上升至20%左右。无论EOS还是LOS, G+球菌对万古霉素、替考拉宁的敏感性均高达90%以上,其次是利奈唑胺、奎奴普汀及利福平,敏感性波动在80-90%。而对于红霉素、部分头孢类(头孢噻肟、头孢唑林及头孢西丁)及部分青霉素类等国内外常用抗生素(青霉素、氨苄青霉素、苯唑青霉素),其敏感性仅波动在20%-40%之间；与G+球菌类似,G-杆菌对部分青霉素类及部分头孢类抗生素(例如氨苄青霉素、头孢唑林等)的敏感性仅为20%-40%。而对于亚胺培南、司帕沙星、环丙沙星及庆大霉素的敏感性均高于70%。另外,在部分常见病原菌药敏分析中,我们发现无论EOS还是LOS,万古霉素在葡萄球菌及肠球菌中的敏感性均高达80%以上。肺炎克雷伯氏菌及大肠埃希氏菌对碳青霉烯类及喹诺酮类抗生素的敏感性也明显高于80%。而对于上述绝大多数细菌而言,大部分青霉素类(例如青霉素、氨苄青霉素、苯唑青霉素)及头孢类(例如头孢噻肟、头孢噻吩以及头孢唑林)等总体上的敏感性均低于30%。另外,真菌对目前临床上使用的抗真菌的药物例如两性霉素B、伊曲康唑及5-氟胞嘧啶等的敏感性仍相对较高,均在70%以上。在病原菌药敏的变迁的研究中,我们发现对于EOS G+球菌而言,近20多年来,部分敏感抗生素的敏感性有所下降,例如万古霉素的敏感性由95%降至65%左右,而庆大霉素由70%降至40%左右,环丙沙星由80%降至50%左右。而对于G-杆菌,在研究期间敏感抗生素例如亚胺培南及环丙沙星的敏感性始终保持在80%以上。而氨苄青霉素的敏感性无论在G+球菌还是G-杆菌中均持续低于40%。同样的变化趋势在LOS中也被发现,在G+球菌中万古霉素及环丙沙星的敏感性均由100%下降至60%左右,而对于G-杆菌,亚胺培南、环丙沙星及庆大霉素的敏感性总体上保持在70%左右。部分青霉素类例如氨苄青霉素及苯唑青霉素敏感性总体上维持在30%以下。结论1.无论EOS还是LOS,最主要的致病菌为G+球菌,其主要构成是葡萄球菌属及肠球菌属。而G-杆菌为NS第二位常见致病菌,主要由肠杆菌属、克雷伯氏菌属及真菌属构成。2.G+球菌及葡萄球菌属的比例在EOS及LOS中均呈明显的下降趋势。G-杆菌在总体上则呈上升趋势,但在EOS中表现为肠杆菌属明显升高,而在LOS中表现为多种G-杆菌如肠杆菌属及克雷伯氏菌属轻微上升。3.真菌属在EOS中所占比例较小,而在LOS中所占比例明显增加,且其比例自2005年有逐年上升趋势。4.药敏研究中发现,无论是EOS还是LOS, G+球菌对万古霉素、替考拉宁及利福平的敏感性均较高,而G-杆菌则对亚胺培南、司帕沙星、环丙沙星及庆大霉素相对比较敏感。5.类似的药敏模式也表现在具体的病原菌药敏分析中,例如葡萄球菌及肠球菌对万古霉素的敏感性最高；而肺炎克雷伯氏菌及大肠埃希氏菌则对碳青霉烯类(例如亚胺培南、美洛培南)及喹诺酮类(例如环丙沙星、司帕沙星及莫西沙星)的敏感性普遍较高。大部分青霉素类例如青霉素、氨苄青霉素及头孢类例如头孢唑林、头孢噻肟、头孢西丁等,对绝大多数病原菌的敏感性均较低。此外,临床上常用抗真菌药物,例如两性霉素-B、伊曲康唑及5-氟胞嘧啶等仍具有较高敏感性。6.与此同时,无论EOS还是LOS, G+球菌的大部分敏感抗生素例如万古霉素、利福平、庆大霉素等的敏感性总体上均呈明显下降趋势,而这种药敏变迁模式在G-杆菌中不明显,均保持较高敏感水平。7.继续动态的、长期的、多中心的针对该地区NS病原菌及其药敏的研究,可以为临床上合理的、适时的予以抗菌治疗提供重要的依据。
[Abstract]:Objective neonatal sepsis (Neonatal sepsis, NS) is a serious infectious disease in the newborn period. The high incidence and mortality rate and mortality of.NS pathogens and their drug sensitivity analysis play an important role in the treatment and prevention. It is clear that the pathogenic bacteria and their drug sensitivity are helpful to the timely, rational selection of antibacterial treatment and the effective reduction of the death of NS. NS pathogenic bacteria and drug sensitivity have regional and temporal differences. This subject aims to study the changes of NS pathogens and their drug sensitivity in southwestern China. Methods the clinical data of 1245 children with NS were collected from January 1, 1993 to September 30, 2014 in the neonatal diagnosis and treatment center of the Affiliated Children's Hospital of Medical University Of Chongqing. A retrospective analysis of the general information of all children, the proportion and changes of the pathogenic bacteria and their drug sensitivity. All data were analyzed and processed by SPSS13.0 version. Results 596 children were diagnosed as early onset sepsis (early-onset sepsis, EOS), and 649 diagnosed as late onset sepsis (late-onset sepsis, LOS) o EOS The main pathogenic bacteria were Staphylococcus (53.6%, n=339), followed by Enterobacteriaceae (12.7%, n=80) and Klebsiella (7.1%, n=45); the main pathogenic bacteria of LOS were Staphylococcus (50.8%, n=356), followed by Enterobacteriaceae (9.8%, n=69), Klebsiella (9.7%, n=68) and fungi (7.4%, n=52). During the study, it was mainly for EOS. The proportion of the pathogenic bacteria G+ dropped from 71% to about 43%, and the second place G- bacilli increased from 14% to about 55%. At the same time, the proportion of the most Staphylococcus in the G+ coccus was reduced from 65% to 37%. As the main pathogen of the G- bacillus, the genus and Klebsiella were increased from 4% to 36%, 2% to 15%, respectively. For LOS, the proportion of G- bacilli increased from 10% to about 38%, and as the main pathogenic bacteria of LOS, the G+ coccus fell from 80% to about 47%. Among them, the proportion of Staphylococcus in G+ was reduced from 68% to 35%, while the genus and Klebsiella in G- bacilli increased from 5% to about 17%, 2% to 18% left. On the other hand, we found that the proportion of fungi in EOS was not high, only 0.5% (n=3), but the proportion in LOS was 7.4% (n=52), and the proportion in LOS increased from 3% to 20% year by year. No matter EOS or LOS, the sensitivity of G+ to vancomycin and teicoplanin was above 90%, followed by linezole. Amines, quetipine and Li Fuping, sensitive to erythromycin, some cefotaxime (cefotaxime, cefazolin and cefoxitin) and some penicillins, and some other common domestic and foreign antibiotics (penicillin, ampicillin, azolicillin) in 80-90%., and its sensitivity only fluctuates between 20%-40%; it is similar to G+ coccus, and G- bacilli The sensitivities of penicillins and some cephalosporins (such as ampicillin, cefazolin, etc.) were only 20%-40%. and for imipenem, sparfloxacin, ciprofloxacin and gentamicin were higher than 70%.. In some common pathogenic bacteria susceptibility analysis, we found that vancomycin was in Staphylococcus and EOS in Staphylococcus and LOS. The susceptibility of Enterococcus to more than 80%. Klebsiella pneumoniae and Escherichia coli are also more sensitive to carbapenems and quinolones than 80%.. For most of these bacteria, most penicillins (such as penicillin, ampicillin, azolicillin) and cefotaxime (e. g. cefotaxime) The sensitivities of cefathiophene and cefazolin were all lower than that of 30%., and the sensitivity of fungi to the current clinical antifungal drugs such as amphotericin B, itraconazole, and 5- fluorcytosine were still relatively high, both above 70%. In the study of the changes in drug sensitivity of pathogenic bacteria, we found that for EOS G+ cocci In the past 20 years, sensitivity to some sensitive antibiotics has declined, such as vancomycin sensitivity from 95% to about 65%, and gentamicin from 70% to about 40%, and ciprofloxacin from 80% to 50%. For G-, sensitive antibiotics, such as amienem and ciprofloxacin, remained in 80% for the period of study. The susceptibility to ampicillin was also found in LOS, both in G+ and G- bacilli, and in LOS, and the sensitivity of vancomycin and ciprofloxacin in G+ decreased from 100% to about 60%, while the sensitivity to G-, imipenem, ciprofloxacin and gentamicin was generally maintained. About 70%. Some penicillins, such as ampicillin and azolicillin, are generally less than 30%. Conclusion 1. of the main pathogenic bacteria, whether EOS or LOS, are G+ coccus, which are mainly composed of Staphylococcus and Enterococcus, and G- bacilli are common pathogens of NS second, mainly from the genus Enterobacter and Klebsiella. The proportion of.2.G+ and Staphylococcus and Staphylococcus in EOS and LOS showed a significant downward trend in EOS and LOS, while.G- showed an upward trend in general, but in EOS, the Enterobacteriaceae increased significantly, while in LOS, a variety of G- bacilli, such as Enterobacteriaceae and Klebsiella, were slightly higher in EOS than in EOS. The proportion of the cases was smaller and the proportion of LOS increased significantly, and the proportion of them increased from year to year in 2005. In the.4. drug sensitivity study, the sensitivity of G+ to vancomycin, teicoplanin and rifampicin was higher in both EOS and LOS, while G- was relatively sensitive to imipenem, ciprofloxacin, ciprofloxacin and gentamicin. Similar drug sensitivity patterns are also shown in specific antimicrobial susceptibility tests, such as Staphylococcus and Enterococcus with the highest susceptibility to vancomycin, while Klebsiella pneumoniae and Escherichia coli are against carbapenems (such as imipenem, meropenem) and quinolones (such as ciprofloxacin, sparfloxacin and moxifloxacin) Most penicillins such as penicillins such as penicillin, ampicillin and cefazoxime, cefotaxime, cefoxitin, and so on, have low sensitivity to most pathogenic bacteria. In addition, clinical antifungal agents such as amphotericin -B, itraconazole and 5- fluorine cytosine still have high sensitivity.6.. At the same time, the sensitivity of most of G+'s sensitive antibiotics, such as vancomycin, rifampicin and gentamicin, was obviously decreased in both EOS and LOS, and the drug sensitivity change mode was not obvious in G- bacilli, and all of them maintained high sensitivity,.7., continued dynamic, long and multicenter of NS disease in the region. The study of the original bacteria and its drug sensitivity can provide important evidence for clinical rational and timely antibacterial treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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