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目的分析新生儿坏死性小肠结肠炎(NEC)的病原菌,从而指导临床合理抗感染治疗。方法回顾性分析2010年1月至2011年12月我院新生儿科收治的NEC患儿病历资料,分析血培养或腹水培养阳性病例的病原菌、药敏及治疗情况。结果共诊治64例NEC患儿,BellⅠ期28例,Ⅱ期10例,Ⅲ期26例,细菌培养阳性27例(43.8%),共33株。其中革兰阳性球菌13株(39.4%),包括屎肠球菌及粪肠球菌共9株,表皮葡萄球菌4株;革兰阴性细菌19株(57.6%),包括肠杆菌科细菌16株;奥默毕赤酵母菌1株(3.0%)。BellⅠ期、Ⅱ期、Ⅲ期患儿细菌感染阳性率差异无统计学意义(血培养P=0.122,腹水培养P=0.135)。革兰阴性细菌对碳青霉烯类抗生素敏感(86.6%);革兰阳性细菌均对万古霉素、利奈唑胺、氯霉素及链霉素敏感(100%)。结论感染是新生儿NEC的重要原因之一,以革兰阴性细菌感染为主。新生儿发生NEC后可首选碳青霉烯类抗生素,再根据细菌培养及药敏结果酌情加用万古霉素。
Objective To analyze the pathogens of neonatal necrotizing enterocolitis (NEC), and to guide clinical rational anti-infective therapy. Methods The clinical data of NEC pediatric patients admitted from January 2010 to December 2011 in our hospital were retrospectively analyzed. The pathogen, drug sensitivity and treatment of positive cases of blood culture or ascitic fluid culture were analyzed. Results A total of 64 cases of NEC were diagnosed and treated in our hospital. There were 28 cases in stage Ⅰ, 10 cases in stage Ⅱ and 26 cases in stage Ⅲ. There were 27 cases (43.8%) positive for bacterial culture in 33 cases. Of which Gram-positive cocci 13 strains (39.4%), including Enterococcus faecalis and Enterococcus faecium a total of 9 strains, Staphylococcus epidermidis 4; Gram-negative bacteria 19 strains (57.6%), including Enterobacteriaceae bacteria 16; 1 yeast Merbau (3.0%). There was no significant difference in the positive rate of bacterial infection between Bell Ⅰ, Ⅱ and Ⅲ children (P = 0.122 in blood culture, P = 0.135 in ascites culture). Gram-negative bacteria were sensitive to carbapenem antibiotics (86.6%); Gram-positive bacteria were all sensitive to vancomycin, linezolid, chloramphenicol and streptomycin (100%). Conclusion Infection is one of the most important causes of neonatal NEC. Gram-negative bacterial infection is the main cause of infection. Carbapenem antibiotics may be the first choice for neonates after NEC, and then add vancomycin as appropriate according to bacterial culture and drug susceptibility results.