极/超低出生体质量儿医院感染败血症的临床特征与病原学分析  

Clinical characteristics of very/extremely low birth weight infants with nosocomial sepsis and etiological analysis

作　　者：富琴琴 沈国松 蒋琦 林梅芳 邓庆先 文革生 

机构地区：[1]浙江省湖州市妇幼保健院新生儿科,浙江湖州313000

出　　处：《中华医院感染学杂志》2016年第21期4955-4957,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划项目(2014KYA208)

摘　　要：目的探讨极/超低出生体质量儿医院感染败血症临床特征、病原学特点。为其预防控制提供依据。方法分析2012年1月-2015年12月间在医院住院的极/超低出生体质量儿医院感染败血症临床资料。结果极/超低出生体质量儿医院感染败血症55例,发生率为11.3%;临床表现主要为反应差,喂养不耐受,心率增快等;分别占83.63%、72.72%、65.45%;血培养结果革兰阴性菌、真菌、革兰阳性菌构成比为59.56%、26.32%、14.03%;革兰阴性菌对哌拉西林/舒巴坦、碳青霉烯类药物敏感;革兰阳性菌仅对万古霉素敏感,真菌对氟康唑等均敏感;细菌、真菌感染患儿外周血C反应蛋白升高率差异无统计学意义;降钙素原增高多见于细菌感染患儿(P<0.05);白细胞、血小板降低多见于真菌和革兰阴性菌感染患儿(P<0.05)。结论极/超低出生体质量儿医院感染败血症临床表现各异,C反应蛋白、降钙素原、血常规是较敏感的早期实验室诊断指标;医院NICU极/超低出生体质量儿医院感染败血症病原菌依次为革兰阴性菌、真菌、革兰阳性菌。OBJECTIVE To explore the clinical features and etiological characteristics of nosocomial sepsis in very/ extremely low birth weight infants so as to provide guidance for the prevention and control. METHODS The clinical data were collected from the very/extremely low birth weight infants with nosocomial sepsis who were hospitalized from Jan 2012 to Dec 2015 and were analyzed. RESULTS Totally 55 very/extremely low birth weight infants had the nosocomial sepsis, with the incidence rate 11.3 ~. The poor response, feeding intolerance, and fast heart rate were the major clinical manifestations, accounting for 83.63%, 72.72%, and 65.45~, respectively, The result of blood culture showed that the constituent ratios of the gram-negative bacteria, fungi, and gram-positive bacteria were 59.56~, 26.32~, and 14.03~, respectively. The gram-negative bacteria were sensitive to piperacillin-sul- bactam and carbapenems; the gram-positive bacteria were only sensitive to vancomycin; the fungi were sensitive to fluconazole. There was no significant difference in the elevated rate of peripheral blood C-reactive protein between the infants with bacterial infections and the infants with fungal infections. The elevation of procaleitonin was com- mon in the infants with bacterial infections （P〈0.05） ; the declined white blood cell counts and blood platelet counts were common in the infants with fungal and gram-negative bacteria infections （P〈0.05）. CONCLUSION The very/extremely low birth weight infants with nosocomial sepsis vary in the clinical manitestations, The Creactive protein, procalcitonin, and blood routine are sensitive early laboratory diagnosis indicators. The pathogens that cause the nosocomial sepsis in tbevery/extremely low birth weight infants are in turn as follows： the gram- negative bacteria, the fungi, the gram-positive bacteria.

关 键 词：低体质量婴儿 病原菌 医院感染 败血症 

分 类 号：R722.1[医药卫生—儿科]