新生儿败血症的临床特征及病原菌耐药性分析  

Clinical characteristics and pathogenic analysis of neonatal sepsis

作　　者：高杰[1] 王莹莹 谢春丹 金闪闪 GAO Jie;WANG Yingying;XIE Chundan;JIN Shanshan(The Huaihe Hospital of Henani Medical University,Kaifeng 475000,Henan,China)

机构地区：[1]河南大学淮河医院,河南开封475000

出　　处：《中国病原生物学杂志》2023年第11期1324-1328,共5页Journal of Pathogen Biology

摘　　要：目的回顾分析新生儿败血症的临床特征和病原菌分布及耐药性,为临床诊断和治疗提供依据。方法选取2019-2021年本院收治的败血症病例为研究对象,并选取同期非感染患儿为对照组。无菌采集患儿股静脉血用于检测。采用全自动微生物鉴定及药敏分析仪进行病原菌鉴定和药敏试验。采用全自动特定蛋白分析仪测定CRP。采用酶联免疫吸附法测定IL-6、IL-8和TNF-α。采用流式细胞仪测定CD64的平均荧光强度。分析IL-6、IL-8、TNF-α和CD64在新生儿败血症诊断中的意义。结果诊断为新生儿败血症81例,占住院新生儿4.85%。新生儿早发性败血症患儿28例,晚发性败血症患儿53例。症状中呼吸困难23例(23/81,28.40%)、体温异常21例(21/81,25.93%)、黄疸17例(17/81,20.99%)、腹胀呕吐7例(7/81,8.64%)和惊厥1例(1/81,1.23%)。检出的革兰阳性菌中金黄色葡萄球菌、表皮葡萄球菌、无乳链球菌、溶血葡萄球菌、肺炎链球菌和粪肠球菌数量分别为:13、11、7、3、2和1株。检出的革兰阴性菌中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和产酸克雷伯菌分别为:18、15、6、1和1株。检出的真菌中白色假丝酵母菌和光滑假丝酵母菌分别为:4和1株。革兰阳性菌对头孢唑啉、头孢曲松、青霉素、红霉素、庆大霉素、复方新诺明、环丙沙星、利福平、妥布霉素、克林霉素和阿米卡星耐药率为:59.46%、54.05%、67.57%、75.68%、32.43%、48.65%、45.95%、8.11%、27.03%、40.54%和2.70%,对替考拉宁和万古霉素未产生耐药性。革兰阴性菌对头孢唑啉、头孢曲松、头孢他啶、四环素、氯霉素、庆大霉素、复方新诺明、环丙沙星、妥布霉素、阿米卡星和亚胺培南耐药率分别为:73.81%、69.05%、47.62%、52.38%、45.24%、50.00%、59.52%、50.00%、40.48%、11.90%和14.29%,对粘菌素未产生耐药性。治疗前和治疗后3 d观察组患儿IL-6、IL-8、CRP、Objective The clinical characteristics and pathogen distribution of neonatal sepsis were reviewed and analyzed,for providing a basis for clinical diagnosis and treatment.Methods The sepsis cases admitted to our hospital were selected from 2019 to 2021 as the research subjects,and selected non infected children in the same period as the control group.The femoral vein blood were collected sisterly from pediatric patients for testing.The pathogen identification were identified and drug sensitivity testing were analyzed by fully automated microbial identification and drug sensitivity analyzer.CRP was measured by a full automatic specific protein analyzer.IL-6,IL-8,and TNF-αwere measured by enzymelinked immunosorbent assay.The average fluorescence intensity of CD64 was measured by flow cytometry.The significance of IL-6,IL-8,TNF-α,and CD64 in the diagnosis of neonatal sepsis were analyzed.Results 81 cases were diagnosed with neonatal sepsis,accounting for 4.85%of hospitalized newborns.There were 28 cases of neonatal early onset sepsis and 53 cases of neonatal late onset sepsis.Among the symptoms,there were 23 cases of dyspnea(23/81,28.40%),21 cases of abnormal body temperature(21/81,25.93%),17 cases of jaundice(17/81,20.99%),7 cases of abdominal distension and vomiting(7/81,8.64%),and 1 case of convulsion(1/81,1.23%).Among the Gram positive bacteria,the number of Staphylococcus aureus,Staphylococcus epidermidis,Streptococcus agalactis,Staphylococcus haemolyticus,Streptococcus pneumoniae and Fecal Enterococcus were 13,1l,7,3,2 and 1 strains,respectively.Among the Gram negative bacteria,the number of Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,and Klebsiella acidogenes were 18,15,6,l,and 1 strains,respectively.Among the detected fungi,there were 4 strains of Candida albicans and 1 strain of Candida smooth,respectively.The resistance rates of gram-positive bacteria to cefazolin,ceftriaxone,penicillin,erythromycin,gentamicin,trimethoprim/sulfamethoxazole,ciprofloxacin,rifampicin

关 键 词：新生儿败血症 临床特征 耐药性 

分 类 号：R378[医药卫生—病原生物学]