新生儿院内感染败血症30例回顾性分析

Clinical analysis of 30 neonates with nosocomial septicemia

目的分析新生儿院内感染败血症的临床特点及高危因素,探讨其防治措施。方法对30例新生儿院内感染败血症的临床资料、病原菌、高危因素及治疗预后进行回顾性分析。结果新生儿院内感染败血症发生率为1.19%,占新生儿败血症的18.86%。病原菌中革兰阴性菌占42.4%,以肺炎克雷伯氏菌为主;革兰阳性菌占21.2%;真菌占36.4%,以念珠菌为主。药敏结果显示肺炎克雷伯菌对亚胺培南、哌拉西林他唑巴坦敏感率分别为91.7%、75.0%,真菌对氟康唑等常用抗真菌药均敏感。早产、低出生体质量、留置中心静脉导管、气管插管及长疗程广谱抗生素联合使用为院内感染的高危因素。结论新生儿院内感染败血症病原菌以肺炎克雷伯菌及念珠菌为主,应加强护理、严格无菌操作、合理使用抗生素及预防性抗真菌治疗,减少院内感染败血症及其并发症的发生。

Objective To study clinical characteristics,pathogens,and risk factors of neonatal nosocomial septicemia and provide evidence for prevention and early treatment of this condition.Methods Clinical data including pathogens,drug sensitivity,risk factors,treatment,and prognosis of 30 neonates with nosocomial infections were retrospectively studied.Results The incidence of neonatal nosocomial septicemia in hospitalized children was 1.19%,accounting for 18.87% of neonatal septicemia.The most common pathogens were Gram-negative bacilli（42.4%）,such as Klebsiella pneumoniae（the most common）,Gram-positive cocci（21.2%）,and Candida（36.4%）.Klebsiella pneumoniae was highly resistant to ampicillin,piperacillin,cefoxitin,cefazolin,and so on.The susceptibility to imipenem and piperacillin-tazobactam for Klebsiella pneumoniae was indicated as high as 91.7% and 75.0%,respectively,in drug sensitivity test.Fungi were highly sensitive to common antibiotics such as fluconazole.Preterm,low birth weight,peripherally inserted central venous catheters,mechanical ventilation,and multi-antibiotics treatment were risk factors for nosocomial infections.Conclusions Klebsiella pneumoniae and Candida were the main pathogens of neonatal nosocomial septicemia.Barrier nursing,strict aseptic techniques for procedures,fluconazole prophylaxis,and rational use of antibiotics might be the effective strategies for preventing neonatal nosocomial septicemia and its complications.