16例新生儿早发性李斯特菌败血症临床特征  

Clinical characteristics of 16 neonates with early-onset sepsis caused by Listeria monocytogenes

作　　者：黄向荣 唐清 杨祖铭[1] 高楚楚 冯宗太[1] HUANG Xiangrong;TANG Qing;YANG Zuming;GAO Chuchu;FENG Zongtai(The Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou,Jiangsu 215002,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)新生儿科,江苏苏州215002

出　　处：《中华医院感染学杂志》2025年第5期723-727,共5页Chinese Journal of Nosocomiology

基　　金：江苏省医学会科研专项基金资助项目[SYH-32034-0080(20230027)]。

摘　　要：目的探讨新生儿早发性李斯特菌败血症的临床特征及预后不良危险因素。方法选取南京医科大学附属苏州医院新生儿科2012年1月-2023年12月收治的16例早发性李斯特菌败血症患儿为研究对象,收集患儿临床资料、实验室检测及药敏试验,分析预后不良的危险因素。结果本院出生14例,发病率为6.7/10万;早产儿13例,占81.25%。发病时间集中在5~11月。16例患儿多在生后即出现临床症状,主要表现为气促呻吟12例、肌张力低下11例、肤色苍白10例和反应差9例等。14例患儿生后6 h内C-反应蛋白(CRP)即有不同程度的升高。预后方面:治愈出院9例、好转出院2例、死亡4例;另1例病情好转,但考虑预后不良自动出院后死亡。存活组与死亡组在血气碱剩余、感染性休克、早期使用敏感抗菌药物、有创机械通气以及CRP峰值方面差异存在统计学意义(P<0.05)。检测的李斯特菌对头孢西丁全部耐药。结论新生儿早发性李斯特菌败血症多见于早产儿、夏秋季发病,多在生后即出现症状,临床表现重、病死率高;对产前怀疑李斯特菌感染的孕妇可使用青霉素类抗感染,新生儿治疗可首选青霉素或氨苄青霉素,严重患儿可联合万古霉素、利奈唑胺治疗。OBJECTIVE To explore the clinical characteristics of the neonates with early-onset sepsis caused by Listeria monocytogenes and analyze the risk factors for adverse treatment outcomes.METHODS A total of 16 neonates with early-onset sepsis caused by L.monocytogenes who were treated in neonatology department of the Affiliated Suzhou Hospital of Nanjing Medical University from Jan.2012 to Dec.2023 were recruited as the research subjects.The clinical data and the results of laboratory test and drug susceptibility testing were collected from the neonates,and the risk factors for the adverse prognosis were analyzed.RESULTS Totally 14 neonates were born in the hospital,and the incidence rate was 6.7/100,000;13 cases were preterm infants,accounting for 81.25%.The peak of the onset ranged between May and November.Most of the 16 neonates showed clinical symptoms instantly after the birth,and the major manifestations included gasping and moaning(12 cases),hypotonia(11 cases),pale skin(10 cases)and poor response(9 cases).Totally 14 neonates showed the rise of C-reactive protein(CRP)in varying degree within 6 hours after the birth.In terms of the treatment outcomes,9 cases were cured and discharged,2 cases were improved and discharged,and 4 cases died.One of another cases was improved and died due to poor prognosis after against-advice discharge.There were significant differences in the decline of base excess,septic shock,use of sensitive antibiotics in early stage,invasive mechanical ventilation and peak value of CRP between the survival group and the death group(P<0.05).All of the L.monocytogenes were tested resistant to cefoxitin,6 to ampicillin,6 to vancomycin,8 to linezolid.CONCLUSIONS The early-onset sepsis caused by L.monocytogenes is common among the preterm neonates and is prevalent in summer and autumn.Most of the cases show the symptoms instantly after the birth,the clinical manifestations are usually severe,and the mortality rate is high.The pregnant women who are suspected for L.monocytogenes infection before the

关 键 词：新生儿败血症 李斯特菌 临床特征 抗菌药物 

分 类 号：R722.131[医药卫生—儿科]