137例新生儿败血症临床分析

Clinical Analysis of 137 Cases of Neonatal Septicemia

目的探讨新生儿败血症的临床特点、病原菌分布及抗生素耐药状况,指导早期诊断、合理防治。方法选择该院新生儿科住院诊断为新生儿败血症的137例病例,对其临床表现、致病菌及药敏试验进行回顾性分析。结果该院诊断败血症病例中血培养阳性率为64.2%。革兰氏阳性菌占72.2%,金黄色葡萄球菌与表皮葡萄球菌分别占43.3%和15.6%,对苯唑西林的耐药率分别为48.7%、42.9%,对青霉素、红霉素耐药率较高,对美罗培南、替考拉宁、万古霉素耐药率较低。革兰氏阴性菌中大肠埃希菌占首位。早期新生儿败血症与晚期新生儿菌种比较,早期败血症革兰氏阴性菌感染率高于晚期,晚期败血症革兰氏阳性菌感染率高于早期,两者比较差异有统计学意义。结论葡萄球菌为该院新生儿败血症主要致病菌;应做好孕期感染的防治,加强围产期及新生儿期保健,以减少新生儿败血症的发生;新生儿可选抗生素少,应根据临床表现,结合药敏合理用药。

Objective To investigate the clinical characteristics of neonatal septicemias admitted in our hospital, and the distribu-tion of pathogens causing neonatal septicemia and their antibiotic resistance so as to guide the early diagnosis and rational preven-tion and treatment. Methods The clinical data of 137 cases of neonates diagnosed with neonatal septicemia in Department of Neonatology of our hospital from January, 2009 to January, 2013 were selected, the clinical characteristics, pathogen and drug sen-sitivity results of the neonates were analyzed retrospectively. Results In 137 newborns with septicemia, the positive blood culture rate was 64.2%, the gram-positive bacteria accounted for 72.2%, of which, staphylococcus aureus accounted for 43.3%, and S. epidermidis accounted for 15.6%. The ratio of oxacillin-resistant staphylococcus aureus and S. epidermidis was 48.7%and 42.9%, respectively, and which had high resistant rates to penicillin and erythromycin, but had low resistant rates to meropenem, te-icoplanin, vancomycin. Escherichia coli was in the first place among gram-negative bacteria. In the comparison of early neonatal septicemia and late neonatal species, the former had a higher gram-negative bacteria infection rate than the latter, and the latter had a higher gram-positive bacteria infection rate than the former, the difference between the two was statistically significant. Conclusion Staphylococcus is the main pathogen of neonatal septicemias in our hospital. Infection should be prevented and treated during pregnancy, and the health care in perinatal and neonatal period should be strengthened so as to reduce the occurrence of neonatal septicemia. Antibiotics for neonates are limited, so rational administration should be based on the clinical manifestations and antimicrobial susceptibility tests.