早发型与晚发型新生儿败血症临床特征及病原学分析  

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

作　　者：曾月瑶 范天群 路玲[2] 韩春华[2] 田清武[2] 姜红[2] 刘冬云[2] Zeng Yueyao;Fan Tianqun;Lu Ling;Han Chunhua;Tian Qingwu;Jiang Hong;Liu Dongyun(Clinical Medical College of Qingdao University Medical Faculty,Qingdao 266000,China;Children’s Medical Center,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学医学部临床医学院,266000 [2]青岛大学附属医院儿童医学中心,266000

出　　处：《中华临床感染病杂志》2021年第5期351-357,共7页Chinese Journal of Clinical Infectious Diseases

基　　金：山东省医药卫生科技发展计划(2017WSB26008)。

摘　　要：目的分析早发型新生儿败血症(Early-onset neonatal sepsis,EONS)与晚发型新生儿败血症(Late-onset neonatal sepsis,LONS)的临床特点、病原学及转归等,以期早期识别NS,指导合理用药。方法收集2014年1月至2020年9月青岛大学附属医院新生儿病房的265例NS患儿临床资料。将所有患儿分为EONS组(n=76)和LONS组(n=189)。分析两组患儿的一般情况、临床表现、实验室检查、病原学分布、治疗及转归情况。采用SPSS 25.0统计软件进行数据分析。结果EONS组羊水污染、孕母产前发热、白细胞计数、中性粒细胞计数异常比例均高于LONS组(P<0.05或<0.01),而LONS组留置经外周插管的中心静脉导管、机械通气、发热、腹胀、血小板计数异常的比例与血清前白蛋白水平均高于EONS组(P<0.05或<0.01)。NS患儿检出革兰阳性菌中表皮葡萄球菌(135/265)、金黄色葡萄球菌(22/265)最多见,革兰阴性菌中大肠埃希菌(13/265)最多见。EONS组和LONS组均检出革兰阳性菌比例最高,分别为85.5%和84.7%,其中主要为凝血酶阴性葡萄球菌中的表皮葡萄球菌。EONS组李斯特菌与链球菌感染比例高于LONS组(P<0.05或<0.01),LONS组金黄色葡萄球菌感染比例高于EONS组(P<0.01)。EONS组病死率(6.6%)高于LONS组(2.6%),但两组比较差异无统计学意义(P>0.05)。结论围产期羊水污染和产前发热是发生EONS的危险因素,中心静脉导管、机械通气是发生LONS的危险因素。血小板计数异常和血清前白蛋白异常在LONS组多见。EONS和LONS检出菌主要为表皮葡萄球菌。应根据EONS和LONS的差异指导临床诊断和治疗。Objective To analyze the clinical characteristics,etiology and outcome of early-onset neonatal sepsis(EONS)and late-onset neonatal sepsis(LONS).Methods The clinical data of 265 neonates with NS admitted in the neonatal ward of the the Affiliated Hospital of Qingdao University from January 2014 to September 2020 were enrolled,including 76 cases of EONS and 189 cases of LONS.The general information,clinical manifestation,laboratory findings,pathogen distribution,treatment and outcome of the two groups were analyzed with SPSS25.0 statistical software.Results The rates of meconium-stained amniotic fluid,prenatal maternal fever,abnormal white blood cell(WBC)count and neutrophil count in EONS group were significantly higher than those in LONS group(P<0.05 or<0.01).However,the rates of indwelling central venous catheters,mechanical ventilation,fever,abdominal distension,abnormal platelet count and serum prealbumin level in LONS group were significantly higher than those in EONS group(P<0.05 or<0.01).Staphylococcus epidermidis(135/265)and Staphylococcus aureus(22/265)were the most common gram-positive bacteria and Escherichia coli(13/265)was the most common gram-negative bacteria in NS.The proportion of gram-positive bacteria was the highest in both EONS group(85.5%)and LONS group(84.7%),which was mainly Staphylococcus epidermidis of coagulase negative staphylococci.The proportion of Listeria monocytogenes and Streptococcus infections in EONS group was significantly higher than that in LONS group(P<0.05 or<0.01).The proportion of Staphylococcus aureus infection in LONS group was significantly higher than that in EONS group(P<0.01).There was no significant difference in case fatality rate between EONS group and LONS group(6.6%vs 2.6%,P>0.05).Conclusions Perinatal amniotic fluid pollution and prenatal maternal fever are risk factors for the occurrence of EONS,while indwelling central venous catheter and mechanical ventilation are risk factors for the occurrence of LONS.Abnormal platelet count and abnormal serum prealbumin

关 键 词：新生儿败血症 早发型败血症 晚发型败血症 病原菌 临床特征 

分 类 号：R722.131[医药卫生—儿科]