新生儿院内细菌感染败血症52例临床分析

Clinical analysis of 52 neonates with nosocomial bacterial sepsis

目的分析新生儿院内细菌感染败血症的临床特点和高危因素,为其防治提供理论依据。方法选取2008年5月至2014年4月南京医科大学附属无锡妇幼保健院收治的52例院内细菌感染败血症新生儿作为研究对象,对其临床表现、病原菌、高危因素及治疗预后进行分析。结果新生儿院内细菌感染败血症的发生率为4.68‰。病原菌中革兰阳性(G+)菌占73.6%,前3位的分别为表皮葡萄球菌、金黄色葡萄球菌、溶血性葡萄球菌。G+菌大多对青霉素耐药,对林克霉素、万古霉素敏感。早产、低出生体质量、留置中心静脉导管为院内细菌感染败血症的高危因素。结论新生儿院内细菌感染败血症的病原菌以G+为主,但对抗生素存在不同程度的耐药;加强早产低出生体质量儿的护理,严格无菌操作可能减少院内细菌感染败血症的发生。

Objective To analyze the clinical characteristics and high risk factors of neonates with nosocomial bacterial sepsis,and provide evidence for clinical treatment. Methods Totally 52 neonates with nosocomial bacterial septicemia from the Neonatology Department of the Maternal and Child Health Hospital Affiliated to Nanjing Medical University were recruited from May 2008 to April 2014. The clinical data,including clinical features,pathogens,high risk factors and outcomes were collected and analyzed. Results The incidence of neonates with nosocomial bacterial sepsis was 4. 68‰. Gram-positive bacterial infection accounted for 73. 6% of nosocomial bacterial sepsis and staphylococcus epidermidis,staphylococcus aureus and staphylococcus haemolyticus were the three most common pathogens. The most of gram-positive bacteria were strongly resistant to penicillin. Fortunately,they were sensitive to clindamycin and vancomycin. Premature birth,low birth weight and indwelling peripherally inserted central catheter were high risk factors of neonates with nosocomial bacterial spesis. Conclusion Gram-positive bacteria are the main pathogens of neonatal nosocomial bacterial septicemia. Improving nursing care for the premature and low birth weight,strict aseptic techniques for procedures might be the effective strategies for preventing sepsis and improving the outcome of neonatal nosocomial bacterial septicemia.