不同胎龄新生儿社区获得性败血症晚发型临床表现及病原学分析

Analysis of clinical manifestations and pathogenic septicemia of newborn babies late onsetsepsis in community acquired

目的总结分析新生儿社区获得性败血症晚发型的临床表现、主要致病菌分布及耐药性。方法回顾性分析2009年1月至2012年12月本院收治的122例(早产41例,足月81例)临床诊断为新生儿社区获得性败血症晚发型患儿的临床资料,进行统计分析。结果新生儿社区获得性败血症晚发型的主要临床表现为反应差(64.7%)、拒乳(57.4%)、体温变化(61.5%)。感染途径以呼吸道、脐部为主。122例共检出病原菌42例,血培养阳性率为34.4%,检出率在早产儿组和足月儿组间比较差异无统计学意义(P>0.05),其中葡萄球菌29例,包括金黄色葡萄球菌10例,凝固酶阴性葡萄球菌14例,肠球菌5例;大肠埃希菌10例。检出的球菌对青霉素、红霉素均耐药,对万古霉素、替考拉宁、利奈唑胺敏感。大肠埃希菌中对阿米卡星、亚胺培南、美罗培南敏感,对头孢唑林、头孢曲松、头孢他啶、头孢哌酮、呋喃妥因也有较高的敏感性。结论新生儿社区获得性败血症晚发型血培养阳性率不高,临床表现无特异性。病原菌主要为凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌。

Objective To summarize the clinical manifestation ,the main pathogenic bacteria distribution and drug resistance of neonatal community acquired sepsis late onset in our hospital .Methods Retrospectively analyse the clinical material of 122 cases （41 premature cases and 81 cases of full term） with neonatal community acquired sepsis late onset ,which were clinically diagnosed , from January 2009 to December 2012 in our hospital .Results The main clinical manifestation of neonatal community acquired sep-sis late onset was poor response（64 .7% ） ,repellent milk（57 .4% ） ,temperature changes（61 .5% ） ,and the respiratory tract and um-bilical region were the main infection ways .42 cases were checked out with pathogen in the 122 cases ,blood culture positive rate was 34 .4% ,and there was no statistically differences between the premature and the full term infant group ,In the 42 cases ,there were 29 cases with staphylococcus ,including 10 cases of staphylococcus aureus ,14 cases of coagulase negative staphylococcus and 5 cases of enterococcus ;and there were 10 cases are checked out with e .coli .All of the coccus detected were resistant to penicillin and erythromycin ,but sensitive to vancomycin ,teicoplanin ,linezolid .The e .coli was sensitive to amikacin ,imipenem ,meropenem ,and al-so had a higher sensitivity to cefazolin ,ceftriaxone ,cefepime ,cefoperazone and nitrofurantoin .Conclusion Blood culture positive rate is not high in neonatal community acquired sepsis late onset ,and its′clinical manifestations are nonspecific .The main pathogenic bacteria is coagulase negative staphylococcus ,staphylococcus aureus ,followed by escherichia coli .