101例新生儿败血症的病原学和临床特点分析

Analysis of the Etiology and Clinical Features of 101 Cases of Neonatal Septicemia

目的分析新生儿败血症的病原学和临床特点。方法对2012年7月至2013年6月淮安市妇幼保健院住院的101例血培养阳性结果且诊断为新生儿败血症患儿的临床资料进行回顾性分析。依据败血症发病时间将病例分为早发型组和晚发型组,比较两组间的差异。结果住院新生儿败血症的发生率是3.2%,临床表现以黄疸、反应低下、肺炎、合并局部感染灶、体温异常、血C反应蛋白升高和需要机械通气为主。早发型组羊水污染的发生率高于晚发型组(χ2=3.918,P=0.048);早发型组黄疸的发生率(79.0%)高于晚发型组(23.1%)(χ2=30.659,P=0.000);早发型组合并局部感染灶的发生率(9.7%)低于晚发型组(38.5%)(χ2=12.044,P=0.001);早发型组肺炎的发生率(27.4%)低于晚发型组(51.28%)(χ2=5.873,P=0.015)。败血症致病菌中,革兰阳性菌占80.2%,革兰阴性菌占13.86%,真菌感染占5.94%。革兰阳性菌大多对力奈唑胺和万古霉素高度敏感;革兰阴性菌对碳青霉烯类抗生素高度敏感;真菌对氟康唑、两性霉素B均敏感。结论早发型和晚发型新生儿败血症临床表现具有各自的特点。临床医师应根据其临床表现和常见致病菌的特点选用抗生素,再根据血培养及药敏试验结果及时调整。

Objective To analyze the etiology and clinical features of neonatal sepsis.Methods The clinical data of 101 newborns with positive blood culture results and diagnosis of neonatal sepsis admitted to Huaian Maternity and Child Healthcare Hospital from Jul.2012 to Jun.2013 were retrospectively analyzed.The patients were classified into early-onset group and late-onset group based on the postnatal age at onset of sepsis.The differences between the two groups were compared.Results The incidence of neonatal sepsis in the hospital was 3.2%,with jaundice,feeble activity,pneumonia,the combined local infection,abnormal body temperature,elevated blood CRP and the need for mechanical ventilation as main the main clinical manifestations.In early-onset group,we found more amniotic fluid pollution（X2 =3.918,P=0.048）,more jaundice （79.0 % versus 23.1% ; x2 =30.569,P =0.000）.The early-onset group had a significantly lower percentage of combined local infection（9.7 % versus 38.5 % ;x2 =12.044,P =0.001）.Incidence of pneumonia in early-onset group was also lowm（27.4% versus 51.3 %,x2 =5.873,P=0.015）.Pathogenic bacteria in sepsis：Gram positive bacteria accounting for 80.2%,Gram negative bacteria accounting for 13.86 % and Fungi accounting for 5.94%.The Gram-positive bacteria were mostly highly sensitive to linezolid and vancomycin;the Gram-negative bacteria were highly sensitive to carbapenems; the fungi were highly sensitive to fluconazol and ampotericin B.Conclusion The clinical manifestations of early-onset and late-onset neonatal sepsis has its own characteristics respectively.Clinicians should choose antibiotics according to their clinical manifestations and the characteristics of the common pathogens,and adjustments should be made based on the result of blood culture and drug sensitive test.