上海某三级综合医院不同来源新生儿细菌主动筛查结果分析

Active screening of bacteria from neonates of different sources in a tertiary general hospital in Shanghai

摘要:

目的 分析上海某三级综合医院新生儿病房不同来源新生儿细菌主动筛查结果,为新生儿感染预防与控制提供依据。方法 回顾性收集该院新生儿病房2017—2023年所有新生儿入院时主动筛查的监测结果, 对比分析产科入院及社区入院新生儿细菌检出变化。结果 2017—2023年入院新生儿共有4 265例,其中产科来源3 339例 (产科来源组)、社区来源926例(社区来源组),主动筛查分别有490、572例新生儿检出细菌。产科来源组新生儿细菌检出率低于社区来源组(14.68% VS 61.77%,P＜0.001);社区来源组新生儿咽部、脐部细菌检出率均高于产科来源组(均P＜0.001);产科来源组、社区来源组新生儿脐部细菌检出率均高于咽部(均P＜0.001)。共检出菌株1 348株,产科来源组新生儿大肠埃希菌、表皮葡萄球菌、粪肠球菌、无乳链球菌及鲍曼不动杆菌检出率高于社区来源组(均P＜0.05),产科来源组新生儿金黄色葡萄球菌、阴沟肠杆菌检出率低于社区来源组(均P＜0.05)。66例新生儿检出多重耐药菌(MDRO),其中产科来源组14例,社区来源组52例;63例新生儿检出耐甲氧西林金黄色葡萄球菌(MRSA)。社区来源组新生儿MDRO和MRSA检出率均高于产科来源组(均P＜0.001);是社区来源组新生儿脐部MDRO检出率高于咽部(P＜0.001)。结论 产科来源组新生儿检出细菌主要是大肠埃希菌,社区来源组新生儿检出细菌主要为金黄色葡萄球菌。新生儿MDRO以MRSA为主,应加强对社区入院新生儿的细菌筛查,预防和控制MDRO尤其社区获得性MRSA在新生儿病房中的传播。

Abstract:

Objective To analyze the active screening results on bacteria from neonates from different sources in the neonatal ward of a tertiary general hospital in Shanghai, provide a basis for the prevention and control of neonatal infections. Methods The monitoring results of active screening on all neonates admitted to the neonatal ward of the hospital from 2017 to 2023 were collected retrospectively. Changes in bacterial detection among neonates admitted from the obstetrics department and the community were compared and analyzed. Results From 2017 to 2023, a total of 4 265 neonates were admitted to the hospital, including 3 339 from department of obstetrics (obstetrics source group) and 926 from community (community source group). Active screening showed that 490 and 572 neonates were detected with bacteria, respectively. Bacterial detection rate of neonates in obstetrics source group was lower than community source group (14.68% vs 61.77%, P<0.001); detection rates of bacteria from pharynx and umbilical site of neonates in community source group were both higher than obstetrics source group (both P<0.001); detection rate of bacteria from neonates’ umbilical site was higher than that from pharynx of both obstetrics source group and community source group (both P<0.001). A total of 1 348 bacterial strains were detected, detection rates of Escherichia coli, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus agalactiae, and Acinetobacter baumannii in the obstetrics source group were all higher than community source group (all P<0.05), detection rates of Staphylococcus aureus and Enterobacter cloacae in the obstetrics source group were both lower than community source group (both P<0.05). 66 neonates were detected multidrug-resistant organism (MDRO), 14 were from obstetrics source group and 52 from community source group, 63 neonates were detected methicillin-resistant Staphylococcus aureus (MRSA). The detection rates of MDRO and MRSA from community source group were both higher than obstetrics source group (both P<0.001); detection rate of MDRO from neonates’ umbilical site was higher than that from the pharynx of the community source group (P<0.001). Conclusion Bacteria detected in the obstetrics source group is mainly Escherichia coli, while that detected from community source group is mainly Staphylococcus aureus. MRSA is the main MDRO from neonates, and bacterial screening of neonates admitted from the community should be strengthened to prevent and control the spread of MDRO, especially community-acquired MRSA in neonatal wards.