上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 专题报道（新生儿基础与临床研究） • 上一篇    下一篇

新生儿科鲍曼不动杆菌感染现状及舒巴坦治疗的评价

颜崇兵，裘 刚，龚小慧，张 泓   

  1. 上海交通大学附属儿童医院新生儿科， 上海 200040
  • 出版日期:2013-07-28 发布日期:2013-08-22
  • 通讯作者: 龚小慧, 电子信箱: xiaohui_gong@hotmail.com。
  • 作者简介:颜崇兵（1984—），男，住院医师，硕士生; 电子信箱: yancb@shchildren.com.cn。

Situation of Acinetobacter baumannii infection in Department of Neonatology and evaluation of sulbactam treatment

YAN Chong-bing, QIU Gang, GONG Xiao-hui, ZHANG Hong   

  1. Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200040, China
  • Online:2013-07-28 Published:2013-08-22

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摘要：

目的 探讨新生儿科鲍曼不动杆菌的感染现状，分析舒巴坦治疗多重耐药鲍曼不动杆菌（MDRAB）感染的疗效。方法 回顾性分析192例新生儿科鲍曼不动杆菌感染病例，对其感染部位和耐药性进行分析，对使用氨苄西林舒巴坦和头孢哌酮舒巴坦联合抗感染的病例进行疗效及安全性分析。结果 2010—2012年新生儿科共收治患儿9 722例，192例分离到鲍曼不动杆菌，感染发生率为1.97%，以呼吸道感染为主。192例患者中，治愈及好转出院171例（89.0％），死亡8例（4.2％），自动出院未知预后13例（6.8％）。对38例MDRAB感染患者给予氨苄西林舒巴坦和头孢哌酮舒巴坦联合治疗，有效25例（65.8％），无效9例（23.7％），死亡4例（10.5％）。31例患者在使用氨苄西林舒巴坦和头孢哌酮舒巴坦联合抗感染前后监测尿素氮、血清肌酐、谷丙转氨酶和谷草转氨酶，提示用药后未造成肝肾功能损害。结论 鲍曼不动杆菌在新生儿科感染总体呈上升趋势，主要为呼吸道感染，且耐药情况严重。使用氨苄西林舒巴坦和头孢哌酮舒巴坦联合抗感染安全，有效性尚可，但有待大规模的临床研究进一步验证。

关键词: 鲍曼不动杆菌, 新生儿, 氨苄西林舒巴坦, 头孢哌酮舒巴坦

Abstract:

Objective To investigate the situation of Acinetobacter baumannii infection in Department of Neonatology, and observe the curative effect of sulbactam on multidrug-resistant Acinetobacter baumannii (MDRAB) infection. Methods The data of 192 cases of Acinetobacter baumannii infection in Department of Neonatology were retrospectively analysed, and the location of infection and drug resistance were investigated. Meanwhile, the efficacy and safety of ampicillin sulbactam plus cefoperazone sulbactam in treatment of infection were evaluated. Results A total of 9 722 cases were admitted to Department of Neonatology between 2010 and 2012, and Acinetobacter baumannii infection developed in 192 (1.97%), most of which were respiratory infection. Among the 192 cases, 171 (89.0%) were cured, 8 (4.2%) died, and the outcomes were not available in the other 13 (6.8%). Thirty-eight cases of MDRAB infection were treated with ampicillin sulbactam plus cefoperazone sulbactam, the favorable clinical response rate was 65.8% (25/38), and there were 9 cases (23.7%) with no response and 4 cases (10.5%) of death. The levels of blood urea nitrogen, creatinine, aspartate aminotransferase and alanine transaminase were monitored before and after treatment with ampicillin sulbactam plus cefoperazone sulbactam in 31 patients, and no therapy-caused hepatic and renal function damage was found. Conclusion The rate of Acinetobacter baumannii infection increases gradually in Department of Neonatology, with serious drug resistance. The efficacy and safety of ampicillin sulbactam plus cefoperazone sulbactam for treatment of Acinetobacter baumannii infection are acceptable, and further studies are needed.

Key words: Acinetobacter baumannii, neonate, ampicillin sulbactam, cefoperazone sulbactam