某院新生儿重症监护室定植菌筛查及临床意义

Screening for bacterial colonization and clinical significance in a neonatal intensive care unit

摘要:

目的了解某院新生儿重症监护室（NICU）收治的新生儿体内细菌定植情况和临床特点。方法对2011年4月—2012年3月入住该院NICU的277例新生儿咽拭子、诱导痰、脐分泌物、血标本进行定植菌筛查或感染菌培养，其中无感染者仅作咽拭子培养。结果277例新生儿中，29例送检标本检测到细菌，细菌检出率为10.47%；菌种包括19株表皮葡萄球菌，5株大肠埃希菌,3株肺炎克雷伯菌，1株金黄色葡萄球菌，1株阴沟肠杆菌。日龄≤2 d的新生儿细菌分离率为2.20%，3～7 d者为21.54%，8～28 d者为36.67%；日龄≤2 d与3～7 d及8～28 d新生儿的细菌分离率差异均有显著性（χ2分别为26.52、46.54，均P＜0.01），日龄3～7 d与8～28 d新生儿的细菌分离率差异无显著性（χ2=2.42，P＞0.05）。结论该院NICU新生儿体内细菌定植以表皮葡萄球菌为主。出生48 h内新生儿细菌定植率低，开展定植菌筛查临床意义不大，建议对出生48 h内的新生儿不再常规进行定植菌筛查，可对出生3 d以上的新生儿进行定植菌筛查。 

Abstract:

ObjectiveTo realize the condition and clinical characteristics of bacterial colonization in newborns in a neonatal intensive care unit(NICU).Methods277 newborns admitted in a NICU from April, 2011 to March 2012 were as studied subjects, newborns’ pharyngeal swab, induced sputum, umbilical secretion and blood specimens were screened for bacterial colonization or infection, newborns without infection were only performed pharyngeal swab culture.ResultsTwentynine newborns’ specimens were detected bacteria,bacterial isolation rate was 10.47%; the isolated bacteria included 19 Staphylococcus epidermidis isolates, 5 Escherichia coli, 3 Klebsiella pneumoniae, 1 Staphylococcus aureus and 1 Enterobacter cloacae.Bacterial isolation rate was 2.20%, 21.54% and 36.67% in newborns aged ≤2 d, 3-7 d and 8-28 d respectively, bacterial isolation rate between newborns ≤2 d and 3-7 d as well as 8-28 d was both significant （χ2=26.52, χ2=46.54 respectively，both P＜0.01）,the difference between bacterial isolation rate of newborns aged 3-7 d and 8-28 d was not significant（χ2=2.42，P＞0.05）. ConclusionThe main colonized bacteria in newborns in this NICU is Staphylococcus epidermidis. Bacterial colonization rate is low in newborns within 48 hours after birth, clinical screen of colonized bacteria is not significant, screen on colonized bacteria in newborns within 48 hours after birth is not recommended, and screen on bacterial colonization in newborns 3 d after birth is suggested.