| Objective:To strengthen the understanding of clinician to bacterial resistance in neonatal intensive care unit(NICU),provide clinical basis for rational use of antibiotics and take corresponding measures to reduce the occurrence of drug-resistant bacteriain NICU,by analyzing the distribution and change of drug resistance rate of pathogenic bacteria,and the risk factors of multiple drug resistance of escherichia coli(E.coli)and klebsiella pneumoniae(KPN)in NICU of our hospital.Methods:The isolated pathogenic bacteria and results of drug susceptibility test of all kinds of specimens of hospitalized children in NICU of our hospital from January 1,2014to December 31,2017 were collected.To study the distribution,change of drug resistance rate of main pathogenic bacteria and the risk factors of multiple drug resistance of E.coli and KPN by retrospective analysis.SPSS18.0 software was applied.Linear trend Chi-square test was used to analyze the distribution of pathogenic bacteria and the change of drug resistance rate.Chi-square test was used for univariate analysis to analyze the possible risk factors of multidrug resistance.Logistic regression analysis was used to analyze the single factor with significant difference.Results:(1)706 strains of pathogenic bacteria were detected in NICU of our hospital in the past four years,including 414 strains of gram positive bacteria(G~+)accounted for 58.64%,289 strains of gram negative bacteria(G~-)accounted for 40.93%,and 3 strains of fungi accounted for 0.43%.The top five strains were staphylococcus epidermidis(Se),E.coli,staphylococcus hominis(S.hominis),enterococcus faecium and KPN.(2)The detection rate of G~+increased showed an upward trend year by year in the past four years(P<0.05),the detection rate of Enterococcus faecium increased year by year(P<0.05),the detection rate of staphylococcus aureus(SA)decreased year by year(P<0.05)and the detection rates of other G~+were no significant change(P>0.05).The detection rate of G~-decreased year by year(P<0.05),the detection rate of KPN decreased year by year(P<0.05),and the detection rates of other G~-were no significant change(P>0.05).(3)The positive samples were mainly from blood,G~+was dominant bacteria.Respiratory tract was the secondary positive sample source and G~-was dominant bacteria.(4)Acineto bacter baumannii(AB)had the highest detection rate in spring,SA had the highest detection rate in winter.(5)The detection rates of extended-spectrum?-lactamases(EBSLs)E.coli and KPN showed a decreasing trend year by year(P<0.05),and detection rate of methicillin-resistant stphylococcus aureus(MRSA)fluctuated slightly in past four years(P>0.05).(6)E.coli,KPN and AB showed high resistance to ampicillin,ampicillin/sulbactam,aztreonam,cefazolin,ceftriaxone and ceftazidime.While they were sensitive to imipenem,cefepime,piperacillin/tazobactam and amikacin.Over the past four years,the drug resistance rate remained stable to most drugs(P>0.05)while increased to a few drugs(P<0.05).(7)Se,S.hominis and SA remained highly sensitive to vancomycin,linezolid and tigacycline with a sensitivity rate of 100%.The resistance rates to oxacillin,penicillin,erythromycin and clindamycin were high.In the past four years,there was no significant change in the drug resistance rate of most drugs(P>0.05),but it decreased in a few drugs(P<0.05).(8)The risk factor of multiple drug resistance of E.coli and KPN was the use of third-generation cephalosporins for three days or more(OR2.76995%CI1.254-6.116P=0.012).Conclusion:(1)G~+was the main pathogen of NICU in our hospital from 2014 to 2017.The detection rate of G~+increased and the detection rate of G~-decreased year by year in the past four years.(2)There were differences in bacterial epidemic characteristics between different specimens and seasons,infection site and seasonal factors should be considered in clinical experience therapy.(3)The resistance rate of the main G~-and G~+bacteria to commonly used clinical penicillins and cephalosporin antibiotics was high and constantly changing,G~-still maintained good sensitivity to enzyme inhibitors and carbapenems,G~+to vancomycin,Linezolid and tigecycline did not develop resistance.(4)Interventions optimizing antibiotic stewardship should be a priority to prevent MDRO infections.(5)Regular monitoring pathogen distribution and the variance of drug resistancechanges in NICU are important to guide the clinical rational antimicrobial agents and to effectively reduce or delay the bacterial resistance. |
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