产前使用抗生素与早产儿早发型及晚发型败血症关系的研究

Relationship of antenatal antibiotic exposure with early-onset or late-onset sepsis in preterm infants

目的探讨母亲分娩前使用抗生素与早产儿早发型败血症(EOS)及晚发型败血症(LOS)发生以及病原菌的关系。方法选取2010年1月至2012年12月间胎龄≤33周,生后24h内住院,住院时间≥24 h的单胎早产儿;将母亲分娩前使用抗生素时间≥4 h作为抗生素组,未使用或使用抗生素时间<4 h为对照组,分析比较两组早产儿EOS和LOS的比例和致病菌情况。结果共入选629例早产儿,其中抗生素组232例,对照组397例。抗生素组早产儿的出生体质量、临床羊膜炎、产前激素>24h、EOS的发生比例均高于对照组,窒息和呼吸窘迫综合征(RDS)的发生比例均低于对照组,差异均有统计学意义(P<0.05);两组LOS发生比例差异无统计学意义(P>0.05)。EOS 29例,5例(17.2%)合并化脓性脑膜炎,抗生素组EOS 16例,血培养阳性11例(68.8%),革兰阳性(G+)菌6例(37.5%),G-菌5例(31.3%);对照组EOS 13例,血培养阳性5例(38.5%),G-菌4例(30.8%),G+杆菌1例(7.7%);均以非耐药菌为主,两组EOS早产儿血培养阳性率和G+菌比例差异均无统计学意义(P>0.05)。LOS 75例,5例(6.7%)合并化脓性脑膜炎,与EOS差异无统计学意义(P>0.05)。抗生素组LOS 29例,血培养阳性17例(58.6%),G+菌6例(20.7%),G-菌9例(31.0%),真菌2例(6.9%);对照组LOS 46例,血培养阳性23例(50.0%),G+菌14例(30.4%),G-菌8例(17.4%),真菌1例(2.2%);均以耐药菌为主,两组LOS早产儿血培养阳性率以及G+菌比例差异均无统计学意义(P>0.05)。结论母亲分娩前使用抗生素,既没有减少早产儿EOS和LOS的发生概率,也未改变病原菌的分布。

Objective To investigate the incidence and pathogen distribution of early-onset sepsis （EOS） and later-onset sepsis （LOS） in preterm infants exposed to antenatal antibiotics. Methods The singleton preterm infants with gestational age 33 weeks who were admitted to our hospital within 24 hours after birth and had stayed for more than 24 hours were selected from Jan. 2010 to Dec. 2012. According to the exposure time of antenatal antibiotics, infants were divided into antibiotics group （I〉4 hours） and control group （〈4 hours）. The proportion of EOS and LOS and pathogen distribution were compared between two groups. Results A total of 629 preterm infants, 232 in antibiotics group and 397 in control group, were selected. Compared with control group, the birth weight, percentages of clinical chorioamnionitis, prenatal hormone exposure 〉 24 h and EOS were significantly higher while percentages of asphyxia and respiratory distress syndrome （RDS） were significantly lower in antibio- tics group （P〈0.05）. There was no difference in the occurrence of LOS between two groups （P〉0.05）. In 29 cases of EOS, 5 cases （17.2%） were complicated by suppurative meningitis. There were 16 cases of EOS in antibiotics group. Positive blood cul- ture was found in 11 cases （68.8%） including 6 Gram-positive （G＋） and 5 Gram-negative （G-） bacteria. There were 13 cases of EOS in control group. Positive blood culture was found in 5 cases （38.5%） including 4 Gram-negative （G-） and 1 Gram-positive （G＋） bacteria. Non-resistant bacteria were dominant in two groups and there was no difference in positive rate of blood culture and proportion of G＋ bacteria between two groups （P〉0.05）. In 75 cases of LOS, 5 cases （6.7%） were complicated by suppura- tive meningitis. There was no difference in incidence of meningitis between EOS and LOS cases （P〉0.05）. There were 29 cases of LOS in antibiotics group. Positive blood culture was found in 17 cases （58.6%） including 6 Gram-positive （G＋） and 9 Gram- negative （G-） bacteria and 2 fungi. There were 46 cases of LOS in control group. Positive blood culture was found in 23 cases （50.0%） including 14 Gram-positive （G＋） and 8 Gram-negative （G） bacteria and 1 fungus. Drug-resistant bacteria were domi- nant in two groups and there was no difference in positive rate of blood culture and proportion of G ＋ bacteria between two groups （P〉0.05）. Conclusions Antenatal antibiotics exposure was not effective to either reduce the occurrence of EOS and LOS or change the distribution of pathogens in EOS and LOS in preterm infants.