不同种类细菌所致早产儿院内感染败血症的临床特点  

Clinical characteristics of sepsis caused by different types of pathogens in preterm infants

作　　者：方广东 陈长春 周勤 余仁强 姜善雨 周洲 FANG Guang-dong;CHEN Chang-chun;ZHOU Qin;YU Ren-qiang;JIANG Shan-yu;ZHOU Zhou(Department of Neonatology,The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China)

机构地区：[1]南京医科大学附属无锡妇幼保健院新生儿科

出　　处：《西安交通大学学报（医学版）》2019年第5期770-773,788,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：江苏省妇幼保健重点学科项目(No.FXK201213);无锡市“科教强卫工程”医学重点学科项目(No.ZDXK003);无锡市医院管理中心医学科研重点项目(No.YGZXZ1528)~~

摘　　要：目的探讨不同种类细菌早产儿院内感染败血症的临床及实验室特点。方法选取2008年5月-2018年4月本院收治的99例院内细菌感染败血症的早产儿作为研究对象,依据血培养结果分为革兰氏阴性菌感染组和革兰氏阳性菌感染组,比较两组的临床表现及实验室结果。结果早产儿院内细菌感染败血症的发病率为1.16%(99/8 512)。感染病原菌中,革兰氏阳性菌占70.3%,主要为表皮葡萄球菌(36.6%);革兰氏阴性菌占29.7%,主要为肺炎克雷伯杆菌(40.0%)。革兰氏阴性菌组严重并发症、白细胞下降、C-反应蛋白(CRP)升高、腹胀、血小板下降的发生率明显高于革兰氏阳性菌组,差异具有统计学意义(P<0.05);革兰氏阴性菌组放弃治疗或死亡率明显高于革兰氏阳性菌组,差异具有统计学意义(P<0.05)。结论早产儿院内细菌感染败血症的主要病原菌为革兰氏阳性菌。革兰氏阴性菌感染更易发生休克、中枢感染、腹胀等并发症,实验室检验更多表现为白细胞、血小板下降及CRP升高;感染早期根据临床表现及实验室结果选用抗生素可能会提高临床用药的合理性。Objective To investigate the clinical and laboratory characteristics of sepsis caused by different types of pathogens in preterm infants.Methods Totally 99 premature infants with sepsis treated at our hospital during May 2008 and April 2018 were analyzed.According to the results of blood culture, they were divided into gram negative bacteria group and gram-positive bacterial infection group.The clinical and laboratory results of the two groups were compared.Results The incidence of nosocomial bacterial sepsis in premature infants was 1.16%(99/8 512).Gram-positive pathogens accounted for 70.3%, with Staphylococcus epidermidis as the main pathogen (36.6%).Gram-negative pathogens accounted for 29.7%, with klebsiella pneumoniae as the main pathogen (40.0%).Compared with those in gram-positive pathogens group, the incidences of severe complications, leukocyte decline, CRP elevation, abdominal distention and thrombocytopenia in gram-negative bacteria group increased significantly ( P <0.05).Compared with gram-positive pathogens group, the abandonment or mortality rate of gram-negative bacteria group was also increased significantly ( P <0.05).Conclusion Gram-positive pathogens are the main pathogens causing sepsis in premature infants.Gram-negative pathogen infection is more prone to complications such as shock, central infection and abdominal distention.Laboratory tests showed leukocyte reduction and thrombocytopenia and elevated CRP.Early selection of antibiotics based on clinical and laboratory results may improve the rationality of clinical medication.

关 键 词：革兰氏阳性菌感染 革兰氏阴性菌感染 早产儿 院内感染 败血症 

分 类 号：R722.1[医药卫生—儿科]