新生儿革兰阳性菌感染败血症的临床特征及诊断分析  

Clinical characteristics and diagnosis of neonatal septicemia caused by gram-positive bacteria infection

作　　者：祁宏亮[1] 李莎莎[2] 赵宏伟[1] 周启立[1] QI Hongliang;LI Shasha;ZHAO Hongwei;ZHOU Qili(Department of Neonatology,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China;Department of physiology,Chengde Medical University)

机构地区：[1]承德医学院附属医院新生儿科,河北承德067000 [2]承德医学院生理学教研室

出　　处：《中国病原生物学杂志》2023年第8期943-947,共5页Journal of Pathogen Biology

基　　金：河北省卫健委2021年度医学科学研究课题(No.20210992)。

摘　　要：目的分析新生儿革兰阳性菌感染败血症的临床特征及诊断指标,为指导临床诊断新生儿败血症提供参考依据。方法回顾性分析98例本院收治的血培养结果阳性的新生儿败血症患儿的临床资料,根据病原菌鉴定结果将患儿分为革兰阳性菌组、革兰阴性菌组及真菌组,对比分析三组患儿的临床表现及实验室检查结果。随机选择同期住院的50例非感染新生儿作为健康对照组,对比分析健康对照组与革兰阳性菌组患儿的炎性指标及凝血指标。提取无乳链球菌DNA,采用PCR方法检测毒力基因的携带情况。结果98例血培养结果阳性患儿,共培养出致病菌98株,其中革兰阳性菌84株、革兰阴性菌14株。主要病原菌为无乳链球菌(23.47%),金黄色葡萄球菌(19.39%),凝固酶阴性葡萄球菌(12.24%),粪肠球菌(10.20%)。按照患儿血培养结果分为两组,两组患儿发生呼吸困难的患儿百分比,PLT降低、血糖异常患儿百分比差异有统计学意义(P<0.05);发生体温异常、反应低下、腹胀或呕吐、面色发绀的患儿百分比,WBC异常、CRP升高患儿百分比,差异无统计学意义(P>0.05)。对比健康患儿与革兰阳性菌组患儿的TNF-α、IL-6、DD、AT-III指标水平,革兰阳性菌组明显高于对照组患儿,差异有统计学意义(P<0.05)。23株无乳链球菌,均检出cfb、hylB、cylE、Imb基因,cspA、scpB、rib、cpsⅢ基因的携带率高于50%。结论新生儿败血症感染的主要病原菌为无乳链球菌。革兰阳性菌首发症状中呼吸困难的发生率高于革兰阴性菌感染患儿,血小板计数降低、血糖异常的发生率低于革兰阴性菌感染患儿。Objective To analyze the clinical characteristics and diagnostic indicators of neonatal septicemia caused by gram-positive bacteria infection,and provide reference for clinical diagnosis of neonatal septicemia.Methods The clinical data of 98 neonates with septicemia admitted to our hospital with positive blood culture results were analyzed retrospectively.According to the pathogen identification results,the children were divided into gram positive bacteria group,gram negative bacteria group and fungus group.The clinical manifestations and laboratory examination results of the three groups of children were compared and analyzed.Randomly select 50 non infected neonates hospitalized at the same time as the healthy control group,and compare the inflammatory indicators and coagulation indicators between the healthy control group and the Gram positive group.DNA of Streptococcus agalactis was extracted,and the virulence gene was detected by PCR.Results A total of 98 strains of pathogenic bacteria were cultured in 98 children with positive blood culture results,including 84 strains of Gram positive bacteria and 14 strains of Gram negative bacteria.The main pathogens were S.agalactis(23.47%),S.aureus(19.39%),coagulase negative Staphylococcus(12.24%)and E.faecalis(10.20%).The patients were divided into two groups according to the results of blood culture.The percentage of children with dyspnea,PLT reduction and abnormal blood glucose in the two groups were statistically significant(P<0.05);The percentage of children with abnormal temperature,low reaction,abdominal distension or vomiting,cyanosis,the percentage of children with abnormal WBC and elevated CRP had no significant difference(P>0.05).Comparing of the levels of TNF-α,IL-6,DD and AT-III between healthy children and children with gram positive bacteria,the Gram positive group were significantly higher than those in the control group,the difference was statistically significant(P<0.05).The cfb,hylB,cylE,Imb genes were detected in 23 strains of S.agalactis.The carryi

关 键 词：新生儿败血症 革兰阳性菌 无乳链球菌 毒力因子 

分 类 号：R378[医药卫生—病原生物学]