新生儿重症监护室晚发型败血症病原菌变迁及耐药性分析

doi:10.12372/jcp.2022.21e1323

Abstract

Abstract:

Objective To analyze the distribution, changes and drug resistance of pathogenic bacteria in late-onset sepsis (LOS) in neonatal intensive care unit (NICU). Methods The clinical data of 223 LOS neonates with positive blood culture admitted to NICU from January 2012 to December 2019 were retrospectively analyzed, and the changes of pathogenic bacteria from year to year were analyzed. Results Among 223 neonates (116 boys and 107 girls), the mean gestational age was (31.9±1.2) weeks, the mean birth weight was (1584.1± 620.9) g, and the median age of LOS was 19.0 (13.0-27.0) days. There were 203 preterm infants and 20 full-term infants. A total of 234 pathogenic strains were detected, most of which were G^- bacteria (128 strains, 54.7%), including 77 strains of Klebsiella pneumoniae. Sixty-nine strains (29.5%) were G⁺ bacteria and 37 strains (15.8%) were fungi. There were significant differences in the detection rates of G^- bacteria, G⁺ bacteria and fungi among different years (P<0.01). The highest detection rates of G^- bacteria and fungi were found in 2016, and the highest detection rates of G⁺ bacteria were found in 2014. The onset time, cesarean section rate, time of premature rupture of membranes >18 hours, antibiotic exposure rate and mortality among G⁺ bacteria, G^- bacteria and fungi groups were significantly different (P<0.05). The cesarean section rate and mortality were higher, and the onset time was shorter in G^- bacteria group. The rate of antibiotic exposure and the proportion of premature rupture time >18 hours were higher in fungi group. Klebsiella pneumoniae (34.9%) was the commonest pathogen causing LOS in premature infants. There was no significant difference in the detection rates of G^- bacteria, G⁺ bacteria and fungi between premature and full-term infants (P>0.05). A total of 109 strains (46.6%) of multiple drug-resistant bacteria were detected and extended-spectrum β-lactamase (ESBLs)-producing Enterobacteriaceae was the dominant strain (74 strains, 67.9%). Conclusions G^- bacteria are the common pathogens causing LOS in NICU, and have serious resistance to commonly used antibiotics. Retrospective analysis of pathogen distribution and resistance characteristics in the NICU on a regular basis is helpful to guide the rational and effective use of antibiotics.

Key words: neonatal intensive care unit, late-onset sepsis, pathogenic bacteria, multidrug-resistant bacteria

ZHANG Liangjuan, SHI Jiao, YANG Junlan, LIU Zhenguo, GUO Jinzhen, LI Zhankui, LI Qinghong. Changes and drug resistance analysis of pathogenic bacteria in late-onset sepsis in neonatal intensive care unit[J].Journal of Clinical Pediatrics, 2022, 40(8): 602-607.

Figures/Tables 6

References 16

[1]	Procianoy RS, Silveira RC. The challenges of neonatal sepsis management[J]. J Pediatr (Rio J), 2020, 96(Suppl 1): 80-86. doi: 10.1016/j.jped.2019.10.004
[2]	中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.
[3]	Pan T, Zhu Q, Li P, et al. Late-onset neonatal sepsis in Suzhou, China[J]. BMC Pediatr, 2020, 20(1): 261. doi: 10.1186/s12887-020-02103-y
[4]	Dong Y, Glaser K, Speer CP. Late-onset sepsis caused by Gram-negative bacteria in very low birth weight infants: a systematic review[J]. Expert Rev Anti Infect Ther, 2019, 17(3): 177-188. doi: 10.1080/14787210.2019.1568871
[5]	Zelellw DA, Dessie G, Worku Mengesha E, et al. A systemic review and meta-analysis of the leading pathogens causing neonatal sepsis in developing countries[J]. Biomed Res Int, 2021, 2021: 6626983.
[6]	Greenberg RG, Kandefer S, Do BT, et al. Late-onset sepsis in extremely premature infants: 2000-2011 [J]. Pediatr Infect Dis J, 2017, 36(8): 774-779. doi: 10.1097/INF.0000000000001570
[7]	Guo J, Luo Y, Wu Y, et al. Clinical characteristic and pathogen spectrum of neonatal sepsis in Guangzhou city from June 2011 to June 2017[J]. Med Sci Monit, 2019, 25: 2296-2304. doi: 10.12659/MSM.912375
[8]	Jiang S, Yang C, Yang C, et al. Epidemiology and microbiology of late-onset sepsis among preterm infants in China, 2015-2018: a cohort study[J]. Int J Infect Dis, 2020, 96: 1-9. doi: 10.1016/j.ijid.2020.03.034
[9]	Li X, Ding X, Shi P, et al. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017[J]. Medicine (Baltimore), 2019, 98(12): e14686. doi: 10.1097/MD.0000000000014686
[10]	Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of enterococci[J]. Microbiol Spectr, 2019, 7(4): 10.
[11]	Lorthe E. Epidemiology, risk factors and child prognosis: CNGOF Preterm Premature Rupture of Membranes Guidelines[J]. Gynecol Obstet Fertil Senol, 2018, 46(12): 1004-1021. doi: S2468-7189(18)30274-5 pmid: 30385352
[12]	Levit O, Bhandari V, Li FY, et al. Clinical and laboratory factors that predict death in very low birth weight infants presenting with late-onset sepsis[J]. Pediatr Infect Dis J, 2014, 33(2): 143-146. doi: 10.1097/INF.0000000000000024 pmid: 24418836
[13]	Dong Y, Glaser K, Speer CP, et al. Late-onset sepsis caused by Gram-negative bacteria in very low birth weight infants: a systematic review[J]. Expert Rev Anti Infect Ther, 2019, 17(3): 177-188. doi: 10.1080/14787210.2019.1568871
[14]	Pokhrel B, Koirala T, Shah G, et al. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal[J]. BMC Pediatr, 2018, 18(1): 208. doi: 10.1186/s12887-018-1176-x
[15]	Jiang Y, Kuang L, Wang H, et al. The clinical characteristics of neonatal sepsis infection in southwest China[J]. Intern Med, 2016, 55(6): 597-603. doi: 10.2169/internalmedicine.55.3930
[16]	何敏, 张勇, 刘德松, 等. 2012-2016年某院新生儿科多重耐药菌的分布与变迁[J]. 中国妇幼保健, 2017, 32(17): 4193-4195.

病原菌	2012 (n=16)	2013 (n=31)	2014 (n=33)	2015 (n=20)	2016 (n=32)	2017 (n=37)	2018 (n=34)	2019 (n=31)	总计 (n=234)
G^-菌	9(56.3)	8(25.8)	9(27.3)	12(60.0)	23(71.9)	24(64.9)	21(61.8)	22(71.0)	128(54.7)
肺炎克雷伯杆菌	6(37.5)	1(3.2)	3(9.1)	7(35.0)	16(50.0)	20(54.1)	14(41.2)	10(32.3)	77(32.9)
大肠埃希菌	1(6.3)	3(9.7)	2(6.1)	1(5.0)	3(9.4)	2(5.4)	3(8.8)	4(12.9)	19(8.1)
黏质沙雷菌	0(0.0)	0(0.0)	2(6.1)	3(15.0)	2(6.3)	2(5.4)	2(5.9)	0(0.0)	11(4.7)
产酸克雷伯菌	0(0.0)	2(6.5)	0(0.0)	1(5.0)	2(6.3)	0(0.0)	0(0.0)	3(9.7)	8(3.4)
产气肠杆菌	2(12.5)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(2.9)	0(0.0)	3(1.3)
其他G^-菌	0(0.0)	2(6.5)	2(6.1)	0(0.0)	0(0.0)	0(0.0)	1(2.9)	5(16.1)	10(4.3)
G⁺菌	4(25.0)	17(54.8)	20(60.6)	5(25.0)	0(0.0)	7(18.9)	7(20.6)	9(29.0)	69(29.5)
屎肠球菌	2(12.5)	11(35.5)	5(15.2)	0(0.0)	0(0.0)	2(5.4)	1(2.9)	2(6.5)	23(9.8)
表皮葡萄球菌	1(6.3)	1(3.2)	5(15.2)	2(10.0)	0(0.0)	2(5.4)	3(8.8)	2(6.5)	16(6.8)
金黄色葡萄球菌	0(0.0)	2(6.5)	2(6.1)	3(15.0)	0(0.0)	0(0.0)	0(0.0)	1(3.3)	8(3.4)
溶血性葡萄球菌	0(0.0)	3(9.7)	4(12.1)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	7(3.0)
头状葡萄球菌	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(2.7)	1(2.9)	3(9.7)	5(2.1)
其他G⁺菌	1(6.3)	0(0.0)	4(12.1)	0(0.0)	0(0.0)	2(5.4)	2(5.9)	1(3.2)	10(4.3)
真菌	3(18.7)	6(19.4)	4(12.1)	3(15.0)	9(28.1)	6(16.2)	6(17.6)	0(0.0)	37(15.8)
光滑念珠菌	0(0.0)	0(0.0)	0(0.0)	2(10.0)	6(18.8)	6(16.2)	5(14.7)	0(0.0)	19(8.1)
白色念珠菌	3(18.7)	6(19.4)	4(12.1)	1(5.0)	2(6.3)	0(0.0)	1(2.9)	0(0.0)	17(7.3)
克柔假丝酵菌	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(3.1)	0(0.0)	0(0.0)	0(0.0)	1(0.4)

项目	G⁺菌(n=69)	G^-菌(n=128)	真菌(n=37)	统计量	P
胎龄(x±s)/周	31.7±3.3	32.1±3.0	31.3±3.9	F=0.98	0.379
出生体质量(x±s)/g	1 602.9±730.3	1 577.3±531.8	1601.1±681.7	F=0.05	0.954
男性[n(%)]	39(56.5)	66(51.6)	19(51.4)	χ²=0.49	0.783
剖宫产[n(%)]	41(59.4)	90(70.3)	16(43.2)	χ²=9.49	0.009
胎膜早破时间>18 h[n(%)]	17(24.6)	19(14.8)	12(32.4)	χ²=6.47	0.039
抗生素暴露[n(%)]	56(81.2)	95(74.2)	37(100.0)	χ²=12.12	0.002
发病时间[M(P₂₅~P₇₅)]/d	20.0(17.5~24.5)	15.0(9.0~25.5)	21.0(15.0~25.0)	H=8.53	0.014
中心静脉置管[n(%)]	48(69.6)	83(64.8)	26(70.3)	χ²=0.65	0.721
机械通气[n(%)]	51(73.9)	75(58.6)	23(62.2)	χ²=4.21	0.122
死亡[n(%)]	2(2.9)	16(12.5)	1(2.7)	χ²=7.27	0.026

病原菌	早产儿(n=212)	足月儿(n=22)
G^-菌	117(55.2)	11(50.0)
肺炎克雷伯杆菌	74(34.9)	3(13.6)
大肠埃希菌	19(9.0)	0(0.0)
黏质沙雷菌	11(5.2)	0(0.0)
产酸克雷伯菌	5(2.4)	3(13.6)
产气肠杆菌	3(1.4)	0(0.0)
其他G^-菌	5(2.4)	5(22.7)
G⁺菌	62(29.3)	7(31.8)
屎肠球菌	23(10.9)	0(0.0)
表皮葡萄球菌	14(6.6)	2(9.1)
金黄色葡萄球菌	4(1.9)	4(18.2)
溶血性葡萄球菌	7(3.3)	0(0.0)
头状葡萄球菌	5(2.4)	0(0.0)
其他G⁺菌	9(4.3)	1(4.6)
真菌	33(15.6)	4(18.2)
光滑念珠菌	17(8.0)	2(9.1)
白色念珠菌	15(7.1)	2(9.1)
克柔假丝酵菌	1(4.7)	0(0.0)

药物	G^-菌(n=128)		肺炎克雷伯杆菌(n=77)		大肠埃希菌(n=19)		黏质沙雷菌(n=11)
药物	R/（R+I+S）	R%	R/（R+I+S）	R%	R/（R+I+S）	R%	R/（R+I+S）	R%
阿米卡星	1/122	0.8	0/77	0.0	1/18	5.6	0/11	0.0
哌拉西林	55/70	78.6	41/50	82.0	8/10	80.0	0/4	0.0
氨苄西林	86/96	89.6	64/67	95.5	11/12	91.7	8/8	100.0
氨曲南	23/63	36.5	20/44	45.5	2/9	22.2	0/4	0.0
头孢曲松	43/63	68.3	32/44	72.7	7/9	77.8	1/4	25.0
左氧氟沙星	11/119	9.2	7/77	9.1	4/18	22.2	0/8	0.0
头孢噻肟	38/58	65.5	27/33	81.8	8/9	88.9	1/6	16.7
头孢吡肟	54/119	45.4	48/77	62.3	5/16	31.3	1/10	10.0
亚胺培南	5/121	4.1	2/77	2.6	1/18	5.6	0/10	0.0
美罗培南	5/103	4.9	2/73	2.7	1/13	7.7	0/8	0.0
哌拉西林/他唑巴坦	6/114	5.3	4/71	5.6	1/17	5.9	0/10	0.0
头孢哌酮/舒巴坦	3/51	5.9	3/27	11.1	0/8	0.0	0/6	0.0

药物	G⁺菌(n=69)		屎肠球菌(n=23)		表皮葡萄球菌(n=16)		金黄色葡萄球(n=8)
药物	R/（R+I+S）	R%	R/（R+I+S）	R%	R/（R+I+S）	R%	R/（R+I+S）	R%
青霉素	58/68	85.3	20/23	87.0	15/16	93.8	5/8	62.5
红霉素	38/46	82.6	2/4	50.0	14/16	87.5	8/8	100.0
庆大霉素	7/43	16.3	3/23	13.0	1/8	12.5	0/1	0.0
左氧氟沙星	19/59	32.2	6/23	26.1	4/14	28.6	0/1	0.0
利奈唑胺	0/65	0.0	0/21	0.0	0/16	0.0	0/8	0.0
万古霉素	0/68	0.0	0/23	0.0	0/16	0.0	0/8	0.0
氨苄西林	15/23	65.2	15/23	65.2	-	-	-	-
苯唑西林	15/17	88.2	-	-	6/8	75.0	1/1	100.0

Changes and drug resistance analysis of pathogenic bacteria in late-onset sepsis in neonatal intensive care unit

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 16

Related Articles 15

Metrics

Comments

Recommended 0

菌种	株数	构成比/%
G^-菌	79	72.5
ESBLs肺炎克雷伯杆菌	58	53.2
ESBLs大肠埃希菌	12	11.0
ESBLs产气肠杆菌	2	1.8
CRKP	2	1.8
ESBLs奇异变形菌	1	0.9
ESBLs黏质沙雷菌	1	0.9
KPC	1	0.9
产碳青霉烯酶非脱羧勒克菌	1	0.9
诱导型AmpC肺炎克雷伯杆菌	1	0.9
G⁺菌	30	27.5
MRCNS	28	25.7
MRSA	2	1.8

[1]	ZHOU Jianguo. Etiologies of death and preventive strategies in extremely preterm infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 654-657.
[2]	HAO Qingfei, CHEN Jing, LIU Lijun, LI Gaopan, CHEN Haoming, ZHANG Jing, GUO Hongxiang, CHENG Xiuyong. Predictive value of neonatal sequential organ failure assessment score for mortality risk of late-onset sepsis in very/extremely low birth weight infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 670-674.
[3]	SUN Jinshan, CHEN Chaoying. Clinical features and prognostic analysis of complicated urinary tract infection in children [J]. Journal of Clinical Pediatrics, 2021, 39(2): 102-.
[4]	XIE Chaoyun, MENG Guiluan, XIONG Yun, et al. Risk factors of multiple bacterial infections in NICU neonates with severe pneumonia [J]. Journal of Clinical Pediatrics, 2020, 38(4): 260-.
[5]	SHAN Mingfeng, ZHOU Kai, TIAN Ye. Hemophagocytic syndrome induced by Streptococcus pneumoniae: a case report and literature review [J]. , 2018, 36(8): 599-.
[6]	TAN Dongqiong, LI Luquan . Clinical comparison of early-onset and late-onset sepsis caused by Escherichia coli [J]. , 2018, 36(7): 510-.
[7]	ZHAO Xiaopeng, LYU Hui, LI Xufang, SONG Yanyan, ZHOU Wei . Analysis of the clinical characteristics of late-onset sepsis in very low birth weight infants [J]. , 2018, 36(3): 161-.
[8]	XIE Zhaoyun, XIONG Yun, SUN Jing, HU Yang, LI Yaofu. Logistic regression analysis of risk factors of multiple drug-resistant infections in neonatal intensive care unit [J]. , 2016, 34(9): 641-.
[9]	WANG Mian, SU Weidong, WANG Qingqing, GAN Wensi. The value of targeted surveillance in control of nosocomial infection in neonatal intensive care unit [J]. , 2016, 34(6): 421-.
[10]	HE Haiying, JIANG Haiyan, LIU Lijun, DU Fenghua, LI Yanhui, ZHAO Changliang. The analysis of bacteriological changes and susceptible factor of nosocomial infection in neonatal intensive care unit [J]. , 2016, 34(12): 922-.
[11]	ZHANG Haiqiong . Analysis of pathogenic bacteria distribution and drug resistance of otitis media in preschool children [J]. , 2016, 34(10): 747-.
[12]	LI Qiuping, MA Qianqian, FENG Zhichun. Prevention and control of nosocomial infection in NICU: current status and future challenges [J]. , 2015, 33(9): 761-.
[13]	YANG Jing, HUA Ziyu. Treatment and prevention of nosocomial infections in neonatal intensive care units [J]. , 2014, 32(9): 808-.
[14]	WANG Mingjie, YU Xiaohe, LI Wen, CAO Chuanding, WU Anhua, LIAO Zhengchang, ZHOU Meijuan, JIANG Ling, GAO Hongmei, YUE Shaojie. Clinical analysis of an nosocomial outbreak of Klebsiella pneumoniae in neonatal intensive care unit [J]. , 2014, 32(9): 850-.
[15]	XIAO Shufang, WU Qian, LI Bin, LI Yangfang, HUANG Hailin, NI Linxian. A ten-consecutive-years study of pathogenic bacteria distribution and drug resistance in children with sepsis [J]. , 2014, 32(7): 629-.