中国药物警戒 ›› 2025, Vol. 22 ›› Issue (8): 909-913.
DOI: 10.19803/j.1672-8629.20240488

• 安全与合理用药 • 上一篇    下一篇

新生儿坏死性小肠结肠炎并败血症病原菌分布、耐药性及用药分析

赵杰1, 高明娥1, 常虹2, 范惠霞1*   

  1. 1山西省儿童医院药剂科,山西 太原 030013;
    2内蒙古科技大学包头医学院药学院,内蒙古 包头 014040
  • 收稿日期:2024-07-17 出版日期:2025-08-15 发布日期:2025-08-13
  • 通讯作者: *范惠霞,女,主任药师·硕导,医院药学管理与临床药学。
  • 作者简介:赵杰,女,硕士,主任药师,儿科临床药学。
  • 基金资助:
    国家自然科学基金资助项目（82060784）; 山西省儿童医院山西省妇幼保健院院内科研基金（201964）

Pathogen Distribution, Drug Resistance and Drug Use in Neonates with Necrotizing Enterocolitis Complicated with Sepsis

ZHAO Jie1, GAO Minge1, CHANG Hong2, FAN Huixia1*   

  1. 1Department of Pharmacy, Shanxi Provincial Children’s Hospital, Taiyuan Shanxi 030013, China;
    2Department of Pharmacy, Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou Inner Mongolia 014040, China
  • Received:2024-07-17 Online:2025-08-15 Published:2025-08-13

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摘要： 目的 探讨新生儿坏死性小肠结肠炎（Neonatal Necrotizing Enterocolitis,NEC）并败血症病原菌分布、耐药性及用药情况。方法 收集某院2019年1月1日至2023年12月31日诊断为NEC的患儿病例资料对其临床特征、病原菌分布和抗菌药物使用情况进行回顾性研究。结果 共纳入155例临床病例,NEC并败血症的高危因素包括：宫内窘迫、肺部感染、呼吸衰竭、感染性休克、泛发性腹膜炎。研究组（n=39）中检出病原菌中屎肠球菌14株（28.57%）,对青霉素类及大环内酯类耐药率均为100.00%;肺炎克雷伯菌对哌拉西林耐药率最高（87.76%）,对美罗培南耐药率为14.29%。对照组（n=116）中检出最多的病原菌为大肠埃希菌（21株,33.33%）,其对氨苄西林耐药率最高（89.0%）。研究组中肺炎克雷伯菌对庆大霉素、头孢他啶、头孢吡肟、氨曲南、阿莫西林/克拉维酸的耐药率均高于对照组,差异具有统计学意义（P<0.05）。研究组纳入的39例NEC并败血症患儿中使用频次最高的前3位抗菌药物为美罗培南27例（69.23%）、头孢哌酮舒巴坦24例（61.54%）、万古霉素15例（38.46%）。结论 NEC并败血症患儿病原菌以肠球菌及肠杆菌科细菌为主,医院抗感染治疗方案基本合理,对美罗培南的耐药率应引起临床重视。

关键词: 坏死性小肠结肠炎, 新生儿, 败血症, 病原菌, 美罗培南, 耐药性, 用药分析

Abstract: Objective To explore the distribution of pathogenic bacteria, drug resistance and drug use in cases of neonatal necrotizing enterocolitis (NEC) with sepsis. Methods The clinical data of neonates diagnosed with necrotizing enterocolitis (NEC) complicated with sepsis in our hospital between 2019 and 2023 was collected to conduct a retrospective study of their clinical characteristics, distribution of pathogenic bacteria and use of antimicrobial drugs. Results A total of 155 clinical cases were included, High-risk factors for necrotizing enterocolitis and sepsis included intrauterine distress, pulmonary infection, respiratory failure, septic shock, and generalized peritonitis. In the study group (n=39), 14 strains (28.57%) of Enterococcus faecium were identified as pathogenic, exhibiting 100% resistance to penicillin and macrolides. Klebsiella pneumoniae showed the highest resistance to piperacillin (87.76%) and meropenem (14.29%). In the control group (n=116), the most common pathogen was Escherichia coli (21 strains, 33.33%), which exhibited the highest resistance to ampicillin (89.0%). In the study group, the resistance rates of Klebsiella pneumoniae to gentamicin, cefotaxime, cefepime, tranexamic acid, and amoxicillin/clavulanic acid were significantly higher than those in the control group (P<0.05). Among the 39 cases of neonatal necrotizing enterocolitis complicated with sepsis in the study group, the most frequently used antibiotics were meropenem (27 cases, 69.23%), cefoperazone-sulbactam (24 cases, 61.54%), and vancomycin (15 cases, 38.46%). Conclusion The pathogenic bacteria among children with NEC combined with sepsis are mostly enterococci and Enterobacteriaceae bacteria, and the anti-infective treatment regimens in our hospital are generally well-grounded. The resistance rate to meropenem should be taken into account clinically.

Key words: Necrotizing Enterocolitis, Neonates, Sepsis, Pathogen, Meropenem, Drug Resistance, Drug Analysis

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