胎膜早破致新生儿感染的病原学分析

Etiology of neonatal infection related to premature rupture of membranes

目的了解胎膜早破导致新生儿感染的常见菌种，以期更好地指导治疗。方法对2007年5月至2010年11月期间住院的16356例住院新生儿资料进行回顾性分析，记录相关资料，包括有无胎膜早破及时间、感染性疾病的发生情况及血培养等检查结果。结果16356例新生儿中有胎膜早破史者3432例（21．0％），其中足月儿1060例（30．9％），早产儿2372例（69．1％）。胎膜早破患儿中感染性疾病的患病率为35．8％（1227／3432）；血培养阳性率为7．6％（260／3432），其中早产儿为6．3％（149／2372），足月儿为10．5％（111／1060），差异有统计学意义（x2=18．370，P=0．000）。在培养出的菌种中，G’球菌占58．5％（152／260），G杆菌占33．8％（88／260），差异有统计学意义（x2=31．695，P=0．000）；常见病原菌依次为表皮葡萄球菌、人葡萄球菌、肺炎克雷伯杆菌、大肠杆菌和溶血性葡萄球菌，共占血培养阳性菌的75．8％。真菌占7．7％（20／260），真菌感染均见于早产儿。胎膜早破时间≤24h者血培养阳性率为7．7％（119／1544），24h〈胎膜早破时间≤72h者为7．2％（99／1382），胎膜早破时间〉72h者为9．6％（42／439），差异无统计学意义（X2=2．701，P：0．259）。结论G球菌是胎膜早破后新生儿感染的主要致病菌，其次是G^＋杆菌；真菌是胎膜早破后致早产儿感染的常见致病菌之一，在临床工作中应予以重视。随胎膜早破时间的延长，患儿血培养阳性率并未增加。

Objective To investigate the common pathogens in neonatal infections with premature rupture of membranes （PROM）. Methods From May 2007 to November 2010, 16 356 neonates who were admitted to Bayi Children＇s Hospital were assigned to this study. The related clinical and laboratory information were recorded, including PROM and its time of duration, results of blood culture and other clinical data. Results A total of 3432 patients accompanyed with PROM among 16 356 infants （21.0%）. There were 1060 full-term neonates （30. 9% ） and 2372 premature infants （69. 1% ） among 3432 PROM cases. The incidence of infectious disease was 35.8% （1227/3432） in infants with PROM. The overall positive rate of blood culture was 7.6% （260/3432） in infants with PROM： 10. 5% （111/1060） in telm infants and 6. 3% （149/2372） in premature infants （X2 = 18. 370,P =0. 000）. The common pathogenic organisms were gram positive （ G ＋ ） cocci （ 58. 5% ） and gram negative （ G - ） bacilli （ 33.8% ） （ X2 = 31. 695, P = 0. 000）. The most common organisms included Staphylococcus epidermidis, Staphylococcus homis, KlebsieUa pneumoniae, Escherichia coli and Hemolytic staphylococci, accounting for 75.8% of the total blood culture positive patients. Fungal infection accounted for 7.7% of the total infectious diseases, which was all in premature infants. The blood culture-positive rate in patients with PROM duration 〈 24 h, t〉24 hand /〉72 h were 7.7% （119/1544） , 7. 2% （99/1382）, and 9. 6% （42/439） （ X2 =2. 701, P = 0. 259 ）, respectively. Conclusions G ＋ coccus is the most common pathogenic bacteria of neonatal infection related to PROM, followed by Gbacillus. Fungi are detected mainly in premature infants. The blood culture-positive rate may not increase with the extension of time of PROM.