| Objective: To creat a dynamic surveillance system for implying a real time surveillance of the change of causative pathogens and antimicrobial resistance in neonatal bacterial infections, to find out their current patterns and the transition, to forecast their short-term trends, to build up a foundation for tracking and forecasting in a long-term and grasp the epidemiological features of the patterns and the transition, and to provide the informations for empirical administration of antimicrobial agents. Methods: Two thousand and two hundred forty seven strains from hospitalized neonates were isolated and detected antimicrobial susceptibility. Relevant clinical informations were collected from Jan 2000 to Feb 2005. These data were divided two parts: the main data including 2163 items taken from Jan 2000 to Dec 2004 were for surveillance and forecast; another 84 items from Jan 2005 to Feb 2005 were for assessment of the accuracy of forecast. All data were built up 12 tables of a database with full functions by SQL. The surveillance system was programmed by using PowerScript, which include establishing several windows and objects with different functions by object oriented programming(OOP) and embedding SPSS by object linking and embedding(OLE). Time series data were produced by our system and analyzed by embedded SPSS. Results: Eighty two species of bacteria were detected in 2163 strains isolated from Jan 2000 to Dec 2004. The proportion of gram-negative bacteria was much than gram-positive bacteria(65.3% vs 34.7%). The predominant pathogens were Klebsiella pneumoniae(20.7%), E coli(18.0%) and CNS(16.2%). Gram-negative bacteria were most common in pneumonia(81.4%), mainly Enterobacter spp, Klebsiella pneumoniae was increasing and E coli was decreasing year after year. Gram-positive bacteria were most common in septicemia(79.3%), the predominant pathogens were CNS, no significant changes in the patterns of pathogens during 5 years. The proportion of gram-negative and gram-positive bacteria was almost similar in omphalitis and conjunctivitis, Staphylococcus aureus and E coli were the predominant pathogens in omphalitis. CNS were the most common pathogens in conjunctivitis. Staphylococcus aureus was the prodominant pathogen in impetigo neonatorum and cocci were most common in meningitis. Gram-negative bacteria were the most common in nosocomial pathogens, there were increasing trends in Acinetobacter baumannii and Streptococcus viridans and decreasing trends in E coli and Streptococcus penumoniae. Antimicrobial drugs whose total bacterial sensitive rates were >50% were vancomycin, rifampin, carbapenems, qinolones, aminoglycosides, piperacillin/tazobactam and cefoxitin, but ones with serious resistance were penicillins, erythromycin, cephalosporins, aztreonam, nitrofurantoin and norfloxacin. The antimicrobial agents with highest sensitive rate to gram-negative bacteria was imipenem(92.9%) and highest to gram-positive bacteria was vancomycin(96.8%). There were 23 kinds of antimicrobial agents whose sensitive rates to nosocomial pathogens were significantly lower than in infections acquired outside of hospital(p<0.05). There were 602 strains produced extended-spectrum beta-lactamase(ESBL),the most frequently pathogens were Klebsiella pneumoniae(56.3%) and E coli(42.5%) whose rates of producing ESBL were 75.7% and 65.6%respectively. The antibiotic whose rate of producing ESBL to all strains was highest was cefpodoxime. Of Staphylococci, 289 strains belonged to MRS, accounting for 58.0%. 11.5% of Staphylococcus aureus was MRSA and 77.7% of CNS was MRCNS. Vancomycin was the most sensitive antimicrobial agent to MRS 98.6% of susceptivity rate. There was a significant reduction in a greater part of antimicrobial susceptibility between MRS and MSS(p<0.05). There were 8 kinds of antimicrobial agents had remarkable changes of their total sensitive rate annually. Cefazolin and cefoxitin had descendent trends, however cefpodoxime, imipenem, nitrofurantoin, norfloxacin, tetracycline and meropenem had ascendent trends. Others a...
|
PDF Full Text Request