17例新生儿李斯特菌败血症的临床特征及结局分析  

Clinical characteristics and outcome analysis of 17 cases of neonatal Listeria septicemia

作　　者：白瑞苗 曾军安 杨云帆 郭金珍 李占魁 BAI Ruimiao;ZENG Junan;YANG Yunfan;GUO Jinzhen;LI Zhankui(Department of Neonatology,Northwest Womens and Childrens Hospital,Shaanxi Xi’an 710061,China)

机构地区：[1]西北妇女儿童医院新生儿科,陕西西安710061

出　　处：《中国妇幼健康研究》2021年第3期453-458,共6页Chinese Journal of Woman and Child Health Research

基　　金：陕西省重点产业创新链(群)-社会发展领域项目(2020ZDLSF02-03)。

摘　　要：目的探讨新生儿李斯特菌败血症的临床特点及诊疗。方法回顾性分析2017年6月至2019年6月西北妇女儿童医院新生儿科重症监护病房收治的17例李斯特菌败血症患儿的临床资料。结果17例患儿中男9例,女8例;11例为早产儿(64.70%),6例足月儿(35.30%)。17例血培养为单核细胞增生性李斯特菌,其中7例脑脊液培养也为单核细胞增生性李斯特菌。16例为早发型感染,1例晚发型感染。临床表现为呼吸急促(9例)、发热(6例)、呼吸困难(2例)、低体温(2例)、皮疹(2例)及惊厥(1例)等;需要常压氧疗3例,需要呼吸机辅助通气(有创和无创)8例;初次选择抗生素为哌拉西林他唑巴坦钠的有8例,选择头孢类抗生素7例。母亲产前发热8例,胎儿宫内窘迫9例,产前超敏C反应蛋白升高7例。母亲产前血培养李斯特菌感染3例,胎盘病理为急性绒毛膜炎10例;17例患儿合并化脓性脑膜炎10例(58.82%),脑脊液培养出单核李斯特菌7例;治愈12例(70.59%),签字出院3例(17.65%),死亡2例(11.76%)。结论新生儿李斯特菌感染是新生儿早期的严重感染性疾病,易导致呼吸衰竭及中枢神经系统感染,病死率高,以早产儿多见,多为早发型。对有产前发热、宫内窘迫、羊水污染及产前感染指标升高的孕产妇及新生儿应警惕李斯特菌感染,尽早进行病原学检测,首选敏感性抗生素治疗。Objective To explore the clinical characteristics,diagnosis and treatment of neonatal Listeria septicemia.Methods Clinical data of 17 neonates with Listeria septicemia admitted to the neonatal intensive care unit of Northwest Women’s and Children’s Hospital from June 2017 to June 2019 were retrospectively analyzed.Result Among 17 cases,9 were males and 8 were females.There were 11 premature infants(64.70%)and 6 full-term infants(35.30%).Seventeen blood culture results showed Listeria monocytogenes,and listeria monocytogenes also found in cerebrospinal fluid culture in 7 cases.There were 16 cases of early onset infection and 1 case of late onset infection.The main clinical manifestations were tachypnea(9 cases),fever(6 cases),shortness of breath(2 cases),hypothermia(2 cases),rashes(2 cases)and convulsion(1 case).Oxygen therapy in 3 cases,while ventilator assisted therapy in 8 cases.In addition,the primary antibiotics selected for the first time in 8 cases were piperacillin and tazobactam sodium,and 7 cases were cephalosporin antibiotics.There were 8 cases of mothers with prenatal fever,9 cases of intrauterine distress,and 7 cases of antenatal hypersensitive C-reactive protein increased.There were 3 cases of Listeria infection in maternal prenatal blood culture,and 10 cases of acute chorioamnionitis in placenta pathology.10 cases(58.82%)of 17 neonates with suppurative meningitis,and 7 cases of Listeria monocytogenes were found in cerebrospinal fluid culture.Finally,12 cases(70.59%)were cured,3 cases(17.65%)were signed out of hospital,and 2 cases(11.76%)died.Conclusion Neonatal Listeria infection is a severe infectious disease in the early stage of a newborn,which can easily lead to respiratory failure and central nervous system infection,and has a high mortality rate.It is more common in premature infants and most of them are early onset.Pregnant women with prenatal fever,intrauterine distress,amniotic fluid contamination,and elevated prenatal infection indicators should be alert to Listeria infection,carry out

关 键 词：单核细胞增生性李斯特菌 败血症 新生儿 临床特征及结局 

分 类 号：R722.131[医药卫生—儿科]