57例早产儿院内细菌感染败血症临床分析  

Clinical analysis of the nosocomial bacterial sepsis in 57 preterm infants

作　　者：方广东[1] 余仁强 姜善雨[1] 李怡[1] 王娟[1] 张敏婕[1] 

机构地区：[1]南京医科大学附属无锡妇幼保健院新生儿科,江苏无锡214002

出　　处：《皖南医学院学报》2015年第6期571-574,共4页Journal of Wannan Medical College

摘　　要：目的：分析早产儿院内细菌感染败血症的临床特点和高危因素,为其防治提供理论依据。方法：选取2009年1月~2014年12月本院收治的57例院内细菌感染败血症的早产儿作为研究对象,对其临床表现、病原菌、高危因素及治疗预后进行分析。结果：早产儿院内细菌感染败血症的发生率为1.21%,主要表现为反应差、呼吸暂停（64.9%）、发热（22.8%）、腹胀（14.0%）;病原菌中革兰阳性（G＋）菌占75.9%,革兰阴性菌（G-）占22.8%;G＋菌中排前三位的分别为表皮葡萄球菌、金黄色葡萄球菌、溶血性葡萄球菌,分别占29.5%、25%、13.6%,对青霉素的耐药率高达100%,对林可霉素、万古霉素普遍敏感,耐药率均在10%以下;G-菌主要为肺炎克雷伯菌（57.14%）和大肠埃希菌（28.6%）,肺炎克雷伯菌对氨苄西林、哌拉西林耐药率高达100%,对美罗培南敏感,未检出耐药菌株。极低出生体质量、留置PICC、气管插管及双胎儿为院内细菌感染败血症的高危因素,比值比（OR值）分别为4.7、4.7、3.6、5.9。结论：早产儿院内感染细菌败血症临床表现多样,病原菌以革兰阳性菌为主,但对常用抗生素存在不同程度的耐药;极低出生体质量、留置PICC、气管插管及双胎儿为院内细菌感染败血症的高危因素。Objective： To analyze the clinical characteristics and high risk factors for preterm infants infected with nosocomial bacterial sepsis for supplying theoretical evidences in prevention and control of such infection in preterm infants. Methods： Totally,57 preterm infants infected with nosocomial bacterial septicemia in our hospital were included from January 2009 to December 2014,and the data were retrospectively analyzed pertaining to the clinical features,potential pathogens causing sosocomial infections,high risk factors acquiring such infections and treatment outcomes. Results： Nosocomial infection rate for bacterial sepsis were 1. 21% in the preterm infants. The clinical pictures were associated with poor neurological response and apnoea（ 64. 9%）,fever（ 22. 8%） and abdominal distension（ 14%）. The potential pathogens were involved in gram-positive bacteria（ 75. 9%） and gram-negative bacteria（ 22. 8%）. The gram-positive bacteria consisted of Staphylococcus epidermidis（ 29. 5%）,Staphylococcus aureus（ 25%） and Staphylococcus haemolyticus（ 13. 6%）,which were hundred percent resistance to penicillin,yet were sensitive to clindamycin and vancomycin,with drug resistance lower than 10%.Gram-negative bacteria were involved in Klebsiella pneumonia（ 57. 14%） and Escherichia coli（ 28. 6%）,in which the Klebsiella pneumonia was found totally resistant to ampicillin and piperacillin,yet sensitive to meropenerm. Nosocomial susceptible risk factors for the premature with bacterial sepsis consisted of very low birth weight,administration of indwelling peripherally inserted central catheter（ PICC） and tracheal intubation as well as twin birth（ OR= 4. 7,4. 7,3. 6 and 5. 9,respectively）. Conclusion： The clinical pictures of nosocomial bacterial sepsis may vary a lot in preterm infants,and gram-positive bacteria is major responsibility for the nosocomial infection and resistant to conventional antibiotics. Infants with very low birth weight and managed with indwelling PICC and

关 键 词：早产儿 院内感染 败血症 临床特点 高危因素 

分 类 号：R722.6[医药卫生—儿科]