胎盘微生物检测在新生儿早发败血症诊断及治疗中的价值  

The value of placental microbial detection in diagnosis and treatment of neonatal early onset sepsis

作　　者：李萍萍[1] 林榕 赖基栋 林新祝 Li Pingping;Lin Rong;Lai Jidong;Lin Xinzhu(Department of Neonatology,Xiamen Key Laboratory of Perinatal-Neonatal Infection,Women and Children's Hospital,School of Medicine,Xiamen University,Fujian,Xiamen 361001,China)

机构地区：[1]厦门市妇幼保健院厦门大学附属妇女儿童医院,新生儿科/厦门市围产-新生儿感染重点实验室,福建厦门361001

出　　处：《发育医学电子杂志》2021年第3期194-199,共6页Journal of Developmental Medicine (Electronic Version)

基　　金：厦门市科技计划重大专项立项(3502Z20171006)。

摘　　要：目的分析胎盘微生物定植情况,探讨胎盘拭子培养在新生儿早发败血症(early onset sepsis,EOS)诊断及治疗中的价值,为临床合理用药提供参考。方法选取2015年5月至2020年5月胎盘拭子培养阳性的孕妇858例。将母亲胎盘培养阳性且新生儿诊断EOS的64例病例纳入EOS组,选取同期母亲胎盘培养阳性,但未诊断EOS新生儿为非EOS组,按1∶4配对病例对照研究,共256例纳入非EOS组。分析胎盘拭子培养的病原体分布情况、病原体常用药物敏感试验结果、胎盘拭子培养阳性与否和EOS的相关性以及两组患儿一般情况、围产期相关危险因素等。结果研究期间胎盘拭子培养阳性858例(9.0%)。共有13种病原体,295例(34.4%)革兰氏阳性菌、504例(58.7%)革兰氏阴性菌、53例(6.2%)真菌、6例(0.7%)混合菌。胎盘拭子培养前3位病原体依次为:大肠埃希菌(51.6%)、肠球菌属(16.3%)、B族溶血性链球菌(group B streptococcus,GBS,10.4%)。EOS组和非EOS组在患儿胎龄、出生体重、性别、分娩方式方面差异无统计学意义(P>0.05)。EOS组前3位病原体分别依次为:大肠埃希菌(50.0%)、肠球菌属(20.3%)及GBS(14.1%)。大肠埃希菌对哌拉西林他唑巴坦和美罗培南敏感性均高(分别为98.0%、99.8%),对头孢噻肟的敏感率为76.1%,63.3%对氨苄西林耐药;肠球菌属对氨苄西林(100%)、万古霉素(100%)均敏感;GBS对青霉素(100%)、万古霉素(100%)均敏感,63.0%对红霉素耐药。胎盘拭子培养阳性与否和EOS的发生无统计学意义(P>0.05)。对于胎盘GBS定植,GBS-EOS发病率高于大肠埃希菌和肠球菌属。母亲合并绒毛膜羊膜炎是胎盘拭子培养阳性伴发EOS的独立危险因素(P=0.001,OR=2.503,95%CI:1.47~4.27)。结论胎盘拭子培养阳性与否与EOS的发生无明显相关性,但孕母合并绒毛膜羊膜炎是EOS的独立危险因素,应给以及时评估,早期合理应用抗生素。Objective To analyze placental microbial colonization,explore the value of placental swabs culture in diagnosis and treatment of neonatal early onset sepsis(EOS),and provide reference for clinical rational drug use.Methods A total of 858 neonates delivered from pregnant women with positive placental swabs culture between May 2015 and May 2020 were enrolled.A 1∶4 matched case control study was carried out.The EOS group(n=64)delivered from pregnant women with positive placental swabs culture as the case group,and the non EOS group(n=256)delivered from pregnant women with positive placental swabs culture were selected as the control group.Analyze the distribution of pathogenic bacteria and the results of drug sensitivity test for pathogens in placental swab culture,and the relationship between positive outcome of placenta swabs culture and the occurrence of EOS.The clinical date and perinatal risk factors of neonates in the two groups were analyzed.Results A total of 858(9.0%)pregnant women obtained positive placental swabs culture during this study period,with 13 pathogens identified.Among these 858 cases,295 cases were part of Gram-positive bacteria(34.4%),504 cases of Gram-negative bacteria(58.7%),53 cases of fungi(6.2%)and 6 cases of mixed bacteria(0.7%).The top three pathogens of placenta swabs culture were Escherichia(E.coli)accounting for 51.6%,Enterococcus accounting for 16.3%,and group B streptococcus(GBS)accounting for 10.4%.There were no statistically significant differences in age,birth weight,gender,and delivery type between EOS group and non-EOS group(P>0.05).The top three pathogens in EOS group were E.coli(50.0%),Entero-coccus(20.3%),and GBS(14.1%).The sensitivity rates of E.coli strains to piperacillin tazobactam and meropenem were high(98.0%,99.8%respectively).The sensitivity rate for cefotaxime was 76.1%.Around 63.3%of E.coli strains were resistant to ampicillin.The sensitivity rate of Enterococcus to ampicillin and vancomycin was as high as 100%.Totally 100%of GBS strains were sensitive to penic

关 键 词：胎盘微生物 胎盘培养 宫内感染 绒毛膜羊膜炎 早发败血症 危险因素 

分 类 号：R722.1[医药卫生—儿科]