新生儿早发型和晚发型败血症的临床特征和病原学分析  

Clinical characteristics and etiological analysis of neonatal early-onset and late-onset septicemia

作　　者：许小艳[1] 王丝雨 米弘瑛[1] 郑瑞[3] 郑鹏程[4] 毕凯 杨景晖[1,5] XU Xiaoyan;WANG Siyu;MI Hongying;ZHENG Rui;ZHENG Pengcheng;BI Kai;YANG Jinghui(Department of Pediatrics,Yunnan Provincial First People′s Hospital,Kunming,Yunnan 650032,China;Dali University,Dali,Yunnan 671000,China;Department of Clinical Laboratory,Yunnan Provincial First People′s Hospital,Kunming,Yunnan 650032,China;Department of Pharmacy,Yunnan Provincial First People′s Hospital,Kunming,Yunnan 650032,China;Yunnan Provincial Clinical Medical Center for Hematological Diseases,Kunming,Yunnan 650032,China)

机构地区：[1]云南省第一人民医院儿科,昆明650032 [2]大理大学,云南大理671000 [3]云南省第一人民医院检验科,昆明650032 [4]云南省第一人民医院药学科,昆明650032 [5]云南省血液疾病临床医学中心,昆明650032

出　　处：《重庆医学》2021年第15期2524-2529,共6页Chongqing medicine

基　　金：云南省科技厅-昆明医科大学联合专项基金项目[2018FE001(-297)];国家自然科学基金地区科学基金项目(81860281);云南省卫生内设研究机构项目(2018NS234);云南省高层次卫生计生技术人才培养经费资助(D-2017054);云南省中青年学术和技术带头人后备人才项目(202105AC160030)。

摘　　要：目的探讨新生儿败血症的临床特征、病原菌及耐药性变化,为临床诊疗提供依据。方法对云南省第一人民医院2015年1月至2019年12月收住新生儿病房的166例新生儿败血症进行回顾性调查,根据发病时间分为早发败血症(EOS)组和晚发败血症(LOS)组,分析临床特征、病原菌分布及耐药率。结果EOS组121例(72.9%),患儿呼吸系统症状、皮肤脓疱、母亲羊水浑浊及胎膜早破发生率明显高于LOS组(P<0.05);LOS组45例(27.1%),黄疸、消化道症状、医院内感染发生率及早期早产儿、极低出生体重儿构成比高于EOS组(P<0.05)。EOS以革兰阴性菌为主(57.0%),凝固酶阴性葡萄球菌(CNS)、唐菖蒲伯克霍尔德菌、大肠埃希菌及无乳链球菌为主要致病菌;LOS以革兰阳性菌为主(62.2%),CNS、大肠埃希菌、肺炎克雷伯菌为主要致病菌。5年间革兰阳性菌以CNS为主,革兰阴性菌年度分布变化较大。常见革兰阳性菌对青霉素类、克林霉素、大环内脂类抗菌药物耐药率较高,未检出对万古霉素及利奈唑胺耐药菌株;常见革兰阴性菌对氨苄西林耐药率高,对β-内酰胺酶抑制剂复合物、碳青霉烯类和氨基糖苷类抗生素耐药率较低。结论CNS是昆明地区新生儿败血症最常见病原体,EOS与LOS临床特征及病原菌不同。Objective To explore the clinical characteristics of neonatal sepsis and the changes of pathogenic bacteria and drug resistance,so as to provide a basis for the clinical diagnosis and treatment.Methods The retrospective investigation was conducted on 166 cases of neonatal sepsis admitted to the neonatal wards of the Yunnan Provincial First People′s Hospital from January 2015 to December 2019.According to the onset time,they were divided into the early-onset sepsis(EOS)group and late-onset sepsis(LOS)group.The clinical characteristics,distribution of pathogenic bacteria and drug resistance rate were analyzed.Results There were 121 cases(72.9%)in the EOS group,and the incidence rates of respiratory symptoms,skin pustules,maternal amniotic fluid turbidity and premature rupture of membranes were significantly higher than those in the LOS group(P<0.05).There were 45 cases(27.1%)in the LOS group,and the incidence rates of jaundice,digestive tract symptoms and nosocomial infection,and the constituent ratio of early premature infants and very low birth weight infants were higher than those in the EOS group(P<0.05).EOS was dominated by Gram-negative bacteria(57.0%),and coagulase-negative staphylococcus(CNS),Burkholderia gladiolus,Escherichia coli and Streptococcus agalactiae were the main pathogenic bacteria.LOS was dominated by Gram-positive bacteria(62.2%),and CNS,Escherichia coli and Klebsiella pneumoniae were the main pathogenic bacteria.The Gram-positive bacteria was dominated by CNS during the five years,and the annual distribution of Gram-negative bacteria had great change.The common Gram-positive bacteria showed the high resistance rates to penicillins,clindamycin and macrocyclic lipid antibacterial drugs,while no bacterial strain resistant to vancomycin and linezolid was yet detetcted.The common Gram-negative bacteria had higher drug resistance to ampicillin and lower resistance toβ-lactamase inhibitor complex,carbapenems and aminoglycoside antibiotics.Conclusion CNS is the most common pathogen of neonatal sep

关 键 词：新生儿败血症 早发型 晚发型 病原学 耐药性 

分 类 号：R722.131[医药卫生—儿科]