早产儿败血症发病的相关危险因素与病原菌分布情况观察  

Risk factors and pathogen distribution in preterm infants with early onset septicemia and late onset septicemia

作　　者：陈建飞[1] 肖佳荔 吴春红 Chen Jianfei;Xiao Jiali;Wu Chunhong(Department of Neonatology,Jiaxing Municipal Maternal and Children′s Hospital,Zhejiang 314000,China)

机构地区：[1]浙江省嘉兴市妇幼保健院新生儿科,314000

出　　处：《中国药物与临床》2020年第1期10-14,共5页Chinese Remedies & Clinics

基　　金：浙江省嘉兴市科技计划项目(2017AY33039)。

摘　　要：目的对早产儿早发型败血症(EOS)与晚发型败血症(LOS)发病的相关危险因素及病原菌分布情况进行分析。方法将2014年2月至2019年2月浙江省嘉兴市妇幼保健院产科出生的1568例早产儿作为研究对象,统计早产儿败血症的发生率。以出生后72 h为界将败血症患儿分为EOS组和LOS组,统计分析早产儿败血症发生的相关危险因素,并比较EOS组与LOS组在临床表现、实验室检查结果、病原菌分布等指标上的差异。结果1568例早产儿中有241例(15.37%)发生败血症;多元Logistic回归分析显示胎膜早破>18 h、宫内感染、侵入性操作等是早产儿败血症发生的高危因素。LOS组呼吸暂停、喂养不耐受发生率明显高于EOS组(P<0.05);EOS组患儿白细胞、C反应蛋白、降钙素原阳性率均高于LOS组患儿(P<0.05);2组病原菌分布均以革兰阴性菌为主,EOS组主要为肺炎克雷伯杆菌、大肠埃希菌等,LOS组主要为肺炎克雷伯杆菌、白假丝酵母菌等。EOS组死亡率为8.60%,高于LOS组3.38%,但差异无统计学意义(χ^2=3.054,P=0.081)。结论早产儿败血症需注意对胎膜早破、侵入性操作等高危因素的观察,在血培养同时根据EOS与LOS患儿的病原菌分布差异合理选用抗生素,以减少耐药菌的产生。Objective To determine the risk factors and pathogen distribution in preterm infants with early onset septicemia(EOS)and late onset septicemia(LOS).Methods A total of 1568 premature infants,who were born in the Department of Obstetrics of our hospital between February 2014 and February 2019,were included in the study.The incidence of sepsis in the premature infants was statistically analyzed.The children with sepsis were divided into EOS group and LOS group at 72 hours after birth.The risk factors related to sepsis in premature infants were statistically analyzed,and the differences in the indicators,such as clinical manifestations,laboratory results,and pathogen distribution were compared between the EOS group and LOS group.Results Of the 1568 preterm infants,241(15.37%)developed sepsis.Multivariate Logistic regression analysis showed that premature rupture of membranes>18 h,intrauterine infection,and invasive operation were high risk factors for sepsis in preterm infants.The incidences of apnea and feeding intolerance in the LOS group were significantly higher than those in the EOS group(both P<0.05).The positive rates of WBC,CRP and PCT in the EOS group were higher than those in the LOS group(all P<0.05).The distribution of pathogens in the two groups was mainly Gram-negative bacteria.The main pathogens were Klebsiella pneumonia and Escherichia coli in the EOS group,and Klebsiella pneumonia and Candida albicans in the LOS group.The mortality rate in the EOS group was higher than that in the LOS group(8.60%vs 3.38%),with no statistically significant difference(χ^2=3.054,P=0.081).Conclusion The clinical manifestations of sepsis in premature infants are non-specific.It is necessary to pay attention to the high-risk factors such as gestational age,birth weight,premature rupture of membranes and invasive operation.Pending reports of blood culture,antibiotics should be rationally selected according to the difference in pathogen distribution between the infants with EOS and LOS to reduce future development of drug-r

关 键 词：婴儿 早产 败血症 血传病原体 危险因素 

分 类 号：R72[医药卫生—儿科]