3月龄以下婴儿B族链球菌感染35例临床分析

Infants with Group B streptococcal infection:a retrospective analysis of 35 cases

目的总结3月龄以下婴儿B族链球菌感染的临床表现、耐药性、抗生素治疗及预后的特点。方法收集2009年1月至2012年12月深圳市儿童医院内科收治的35例经血、脑脊液、鞘膜积液培养证实为B族链球菌感染患儿的临床资料,回顾分析其发病年龄、生产史（生产方式、羊水有无污染）、临床表现、影像学变化、药敏试验、脑脊液检验结果、抗生素治疗过程（抗生素种类及疗程）以及临床预后。结果 35例患儿中男23例,女12例。血培养31例,脑脊液培养3例,鞘膜积液培养1例。顺产27例,剖宫产8例,其中羊水污染3例。外周血白细胞升高14例（40%）,正常13例（37.1%）,降低8例（22.9%）,C反应蛋白（CRP）升高15例（42.9%）,正常20例（57.1%）;8例检测降钙素原,7例（87.5%）升高。药物敏感实验结果提示B族链球菌菌株对四环素和红霉素耐药率分别为97.0%、66.0%,对青霉素、头孢菌素、万古霉素敏感率为100.0%。抗生素治疗：初始治疗时使用青霉素10例,头孢类17例,美罗培南8例,合用万古霉素2例,合用利奈唑胺5例。化脑性脑膜炎10例中,初始治疗青霉素、头孢类抗生素共4例,美罗培南6例。此后因脑脊液检查蛋白未恢复正常,更换为美罗培南1例,万古霉素1例,利奈唑胺2例,而此4例出院时脑脊液蛋白也未改善。本组病例患儿病情均有好转,出院随访3~6个月临床治愈,其中合并大肠埃希菌感染1例遗留有动眼神经损伤后遗症。结论 B族链球菌感染在3月龄以内小婴儿中并不少见;对败血症及脑膜炎的患儿应按照药敏实验给予青霉素及头孢类抗生素治疗,不必升级抗生素;B族链球菌脑膜炎的预后均较好,无死亡病例。

Objective To investigate the clinical manifestations,susceptibility,antibiotic treatment and prognosis features in infants with Group B Streptococcal（GBS）infection.Methods There were 35 patients with GBS infection from January2009 to December 2012 who were confirmed by blood,cerebrospinal fluid and hydrocele of tunica vaginalis culture.The age of onset,production history（whether spontaneous or amniotic fluid had pollution）,clinical manifestation,imaging findings,results of bacterial drug susceptibility test,biochemical,cerebrospinal fluid test results,antibiotic treatment（antibiotics and period of treatment）and prognosis of these children were analyzed retrospectively.Results Thirty-five infants（male：23,female：12）were included in this retrospective analysis. Cultures were carried out in all children including blood（n=31）,cerebrospinal fluid（n=3）and hydrocele of tunica vaginalis（n=1）.In these cases,27 cases were spontaneous,8 cases were cesarean section and amniotic fluid pollution of 3 cases existed. Increase of peripheral blood leukocytes was noticed in 14infants（40%）,on the contrary,decrease of leucocytes was noticed in 8 infants（22.9%）,and the number of leucocytes was normal in 13 infants（37.1%）. Increase of C-reactive protein was noticed in 15 infants（42.9%）. Eight patients underwent determination of procalcitonin（PCT）,and the results showed increase of PCT in 7 patients（87.5%）.In the antibiotics sensitive experiment,rate of the resistance to tetracyclin and erythromycin were 97% and 66 %,while the sensitive rate was100% to penicillin,cephalosporin and glycopeptide. Antibiotic therapy：in the initial treatment,meropenem was used in 8 cases,combined linezolid in 5 cases and vancomycin in 2 cases,penicillins in 10 cases,cephalosporins in 17 cases. In the initial treatment of 10 cases with cerebral meningitis,4cases were given penicillin or cephalosporin,6 cases meropenem.Because cerebrospinal fluid protein of the babies with purulent meningitis didn＇t obvious improvement,antibiotic was replaced by meropenem and vancomycin in 1 case,linezolid in 2 patients,but after upgrade of antibiotics the cerebrospinal fluid has not been significantly improved. All the cases in the this group had improved,follow-up of 3-6 months showed that clinical cure was achieve. Only 1 case combined with Escherichia coli infection was left with oculomotor nerve injury sequelae.Conclusion To cases of GBS septicemia and combined meningitis,penicillin and cephalosporin antibiotics should be given according to the drug sensitivity test,and it should not blindly upgrade antibiotics.Prognosis of all cases is good,and there is no death.