早产儿重症监护病房实验室确诊败血症病原分布及临床特点  

Distribution and clinical characteristics of pathogens in laboratory confirmed septicemia in premature infants in intensive care unit

作　　者：常淑婷[1] 刘新晖[1] 李强[1] 马金霞[1] 庄严[1] 高喜容[1] 谭李红[1] CHANG Shu-ting;LIU Xin-hui;LI Qiang;MA Jin-xia;ZHUANG Yan;GAO Xi-rong;TAN Li-hong(Department of Newborn,Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院新生儿科

出　　处：《中国感染控制杂志》2020年第1期37-41,共5页Chinese Journal of Infection Control

基　　金：湖南省科学技术厅重点研发项目（2017SK2154）;2020年度湖南省卫生计生委科研计划项目C类课题（20200333）

摘　　要：目的调查重症监护病房败血症早产儿病原菌分布及其临床特点。方法回顾性分析2016年1月—2018年12月某院早产儿重症监护病房收治的血培养阳性,实验室确诊败血症155例,对不同病原菌早产儿败血症临床特点进行比较。结果155例早产儿败血症中,革兰阴性(G-)杆菌组76例(占49.03%),以肺炎克雷伯菌败血症为主;革兰阳性(G+)球菌组42例(占27.10%),以表皮葡萄球菌败血症为主;真菌组37例(占23.87%),以近平滑假丝酵母菌、白假丝酵母菌败血症为主。G-菌组和真菌组早产儿胎龄、出生体重小于G+菌败血症组;真菌败血症组早产儿起病日龄大于G-菌组、G+菌组,深静脉置管比例高于G-菌组、G+菌组;真菌组早产儿血小板计数低于G-菌、G+菌组;G-菌组C反应蛋白(CRP)高于G+菌组和真菌组,差异均有统计学意义(均P<0.05)。155例早产儿治愈好转率94.84%,病死率5.16%。G-菌组患儿病死率高于G+菌组、真菌组,真菌败血症组治疗日数长于G-菌、G+菌组,差异均有统计学意义(均P<0.05)。结论早产儿败血症致病菌主要为G-菌,G-菌组、G+菌组及真菌组败血症早产儿临床表现不同、实验室指标及预后不同。Objective To investigate the pathogenic distribution and clinical characteristics of premature infants with septicemia in intesive care unit(ICU).Methods 155 premature infants with septicemia confirmed by laboratory positive blood culture were retrospectively analyzed,these infants were admitted in ICU of a hospital from January 2016 to December 2018,clinical characteristics of septicemia in premature infants with different pathogens were compared.Results Among 155 premature infants with septicemia,76 cases(49.03%)were in Gram-negative bacillus group(G-group),mainly Klebsiella pneumoniae septicemia;42 cases(27.10%)were in Gram-positive coccus group(G+group),mainly Staphylococcus epidermidis septicemia;37 cases(23.87%)were in fungus group(fungus group),mainly Candida parapsilosis septicemia and Candida albicans septicemia.The gestational age and birth weight of premature infants in G-group and fungus group were less than G+group;disease onset age of premature infants in fungus group was older than G-group and G+group,proportion of deep vein catheterization was higher than G-group and G+group;platelet count of premature infants in fungus group was lower than G-group and G+group;C-reactive protein(CRP)of G-group was higher than G+group and fungus group,difference were all statistically significant(all P<0.05).The recovery rate and mortality of 155 premature infants were 94.84%and 5.16%respectively.Mortality of premature infants in G-group was higher than G+group and fungus group,treatment days of fungus group were longer than G-group and G+group,differences were all statistically significant(all P<0.05).Conclusion The main pathogens of septicemia in premature infants are G-bacteria,clinical manifestations,laboratory markers and prognosis of septicemia children in G-group,G+group and fungus group are different.

关 键 词：败血症 脓毒症 细菌 真菌 新生儿 早产 

分 类 号：R722.131[医药卫生—儿科]