目的:新生儿败血症(NS)没有特定的临床表现,血液培养分析需要较长时间。在选择经验性治疗以降低发病率和死亡率时,了解流行的细菌分离株及其抗生素敏感性至关重要。本文综述了中国新生儿血流感染相关病原菌的分布特点及耐药性,因此可以作为儿科医生的参考。
方法:全文期刊数据库,CNKI,使用关键词“新生儿”进行搜索,“败血症”,和“细菌病原体”检索2016年至2018年4月发表的相关文献。从所选论文中提取以下数据:标题,病原体收集时间,护理单元名称,省(市),血液感染中细菌病原体的分布,和主要病原菌的耐药性。
结果:共检索86篇,其中30项符合研究要求,因此纳入审查;均为回顾性研究.文章共涵盖来自24个城市的4098株细菌(革兰氏阳性菌2494株,1429革兰氏阴性菌,176种真菌)。在革兰氏阳性菌中,检出率最高的4种病原菌为凝固酶阴性葡萄球菌(CoNS)(40.23%),链球菌(6.81%),肠球菌(6.10%),和金黄色葡萄球菌(S.金黄色葡萄球菌)(5.15%);在革兰氏阴性菌中,克雷伯菌(14.52%),大肠杆菌(12.12%),阴沟肠杆菌(1.90%),假单胞菌(1.41%)检出率最高。念珠菌和其他真菌的检出率为4.29%。在临床检出率较高的病原菌中,表皮葡萄球菌和金黄色葡萄球菌对红霉素和青霉素均具有高度抗性。对表皮葡萄球菌和金黄色葡萄球菌均具有高疗效的抗菌药物包括万古霉素,环丙沙星,庆大霉素,利奈唑胺,利福平,还有四环素.肺炎克雷伯菌和大肠埃希菌对氨苄青霉素耐药率较高,但是有两种药物都有很高的疗效,包括亚胺培南,哌拉西林/他唑巴坦,氨基糖苷类(庆大霉素,阿米卡星),和喹诺酮类药物(左氧氟沙星,环丙沙星)。与2017年中国抗菌药物耐药监测系统(CARSS)报告的耐药数据相比,败血症新生儿血培养中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCoNS)的检出率均超过全国平均耐药水平(p<0.01)。肺炎克雷伯菌对第三代头孢菌素的耐药率高于全国平均耐药水平(p<0.01),但是这种生物对碳青霉烯类最敏感(碳青霉烯类抗性是指对任何亚胺培南的抗性,美罗培南,或厄他培南)。大肠埃希菌对喹诺酮类药物的耐药性优于全国平均水平(p<0.01)。
结论:新生儿重症监护病房(NICU)的医疗护理相关感染更常由CoNS引起,而不是由金黄色葡萄球菌和革兰氏阴性菌引起。万古霉素仍然是治疗确诊感染的首选药物,因为大多数分离的CoNS对包括青霉素在内的β-内酰胺药物具有抗性。对于革兰氏阴性肠道细菌,氨基糖苷类和碳青霉烯类足以治疗。与CARSS有关细菌耐药性的数据相比,这篇综述中关于引起NS的病原体耐药性的数据并不令人满意。NICU抗生素管理的下一个目标必须是制定减少抗生素使用的策略。
OBJECTIVE: Neonatal sepsis (NS) has no specific clinical manifestations and blood culture analysis requires a long period of time. Knowledge of prevalent bacterial isolates and their antibiotic susceptibility is crucial when choosing an empirical therapy to decrease morbidity and mortality. This literature
review summarizes the distribution characteristics and antimicrobial resistance of bacterial pathogens associated with bloodstream infections in Chinese neonates, and thus serves as a reference for pediatricians.
METHODS: The full-text journal database, CNKI, was searched using the key words \"neonatal\", \"sepsis\", and \"bacterial pathogen\" to retrieve relevant literature published from 2016 up to April 2018. The following data were extracted from the selected papers: title, pathogen collection time, care unit name, province (city), distribution of bacterial pathogens among bloodstream infections, and antimicrobial resistance of major pathogens.
RESULTS: A total of 86 articles were searched, of which 30 complied with the study requirements and thus were included in the
review; all were retrospective studies. The articles covered a total of 4098 bacterial strains from 24 cities (2494 Gram-positive bacteria, 1429 Gram-negative bacteria, 176 fungi). Among the Gram-positive bacteria, the four pathogens with the highest detection rates were coagulase-negative staphylococci (CoNS) (40.23%), Streptococci (6.81%), Enterococci (6.10%), and Staphylococcus aureus (S. aureus) (5.15%); among the Gram-negative bacteria, Klebsiella (14.52%), Escherichia coli (12.12%), Enterobacter cloacae (1.90%), and Pseudomonas (1.41%) had the highest detection rates. The detection rate of Candida and other fungi was 4.29%. Among the pathogens with high clinical detection rates, S. epidermidis and S. aureus are highly resistant to both erythromycin and penicillin. Antibacterial drugs with high efficacy for both S. epidermidis and S. aureus include vancomycin, ciprofloxacin, gentamicin, linezolid, rifampicin, and tetracycline. Klebsiella pneumoniae and Escherichia coli are highly resistant to ampicillin, but there are drugs with high efficacy for both, including imipenem, piperacillin/tazobactam, aminoglycosides (gentamicin, amikacin), and quinolones (levofloxacin, ciprofloxacin). In contrast to the drug resistance data reported by the China Antimicrobial Resistance Surveillance System (CARSS) in 2017, the detection rate of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceeded the national average drug resistance level (p < .01). The resistance rate of K. pneumoniae to third-generation cephalosporins was higher than the national average drug resistance level (p < .01), but this organism was most sensitive to carbapenems (carbapenem resistance refers to resistance to any of imipenem, meropenem, or ertapenem). The resistance of Escherichia coli to quinolones was better than the national average level (p < .01).
CONCLUSIONS: Medical care-related infections in neonatal intensive care units (NICUs) were more often caused by CoNS than by S. aureus and Gram-negative bacteria. Vancomycin remains the preferred drug for treating confirmed infections, because most isolated CoNS are resistant to β-lactam drugs including penicillin. For Gram-negative enteric bacteria, aminoglycoside and carbapenem were sufficient for treatment. Compared to the CARSS data on bacterial resistance, the data in this
review on the resistance of pathogens causing NS were not favorable. The next goal in antibiotic management in NICUs must be to develop strategies to reduce the use of antibiotics.