新生儿医院感染败血症临床分析

Clinical characteristics of neonates with septicemia induced by nosocomial infections

目的分析新生儿医院感染败血症的临床特点、病原学变化及高危因素,为诊治提供依据。方法调查2010年1月-2013年7月收治新生儿9 432例,回顾性分析新生儿医院感染败血症的临床资料、病原菌及药敏、高危因素及预后,所有数据采用SPSS11.5软件进行统计分析。结果 9 432例新生儿发生医院感染败血症51例,发生率0.54%;检出病原菌中革兰阳性菌占29.55%,以凝固酶阴性葡萄球菌为主,革兰阴性菌占45.45%,以肺炎克雷伯菌为主,真菌占25.00%,以光滑假丝酵母为主;凝固酶阴性葡萄球菌存在较严重耐药性,革兰阴性菌存在多药耐药菌现象,肺炎克雷伯菌多药耐药更为突出,其对氨苄西林、哌拉西林耐药率为100.00%;真菌对氟康唑、酮康唑敏感率100.00%;早产、低出生体质量、留置中心静脉导管、脂肪乳使用及长疗程广谱抗菌药物联合使用等是发生医院感染败血症的高危因素;临床表现非特异性,与其他感染或新生儿期常见现象较难区别。结论加强感染指标监测,尽早诊断和采取积极措施控制感染,可有效地降低新生儿医院感染败血症的发生率。

OBJECTIVE To analyze the clinical characteristics of the neonates with septicemia induced by nosocomial infections and observe the etiological change and high risk factors so as to provide guidance for clinical diagnosis and treatment .METHODS A total of 9 432 neonates who were treated in the hospital from Jan 2010 to Jul 2013 were recruited in the study ,then the clinical data of the neonates with septicemia induced by nosocomial infec-tions ,pathogens ,drug susceptibility ,high risk factors ,and prognosis were retrospectively analyzed ,and all the data were statistically analyzed with the use of SPSS11 .5 software .RESULTS The nosocomial infections-induced septicemia occurred in 51 of 9 432 neonates ,with the incidence rate of 0 .54% .Among the pathogens isolated ,the gram-positive bacteria accounted for 29 .55% ,the gram-negative bacteria 45 .45% ,the fungi 25 .00% ;the coagu-lase-negative Staphylococcus was the predominant species of gram-positive bacteria ,the K lebsiella pneumoniae was dominant among the gram-negative bacteria ,and the Candida glabrata was the predominant species of fungi . The coagulase-negative Staphylococcus was highly drug-resistant ,the gram-negative bacteria showed multidrug-resistant ,the K .pneumoniae strains showed more prominent multidrug-resistance ,the drug resistance rates to ampicillin and piperacillin were 100 .00% ;the drug susceptibility rates of the fungi to fluconazole and ketoconazole were 100 .00% .The preterm ,low birth weight ,central venous catheter indwelling ,use of fat emulsion ,and long course of combination use of broad-spectrum antibiotics were the high risk factors for the nosocomial infections-in-duced septicemia ;the clinical manifestations were not specific and were hard to distinguish from other infections and common diseases during the neonatal stage .CONCLUSION It is an effective way to strengthen the monitoring of infection indicators ,diagnose in a timely manner ,and actively take control measures so as to reduce the inci-dence of the nosocomial infections-induced septicemia in the neonates .