38例足月与早产新生儿败血症临床特点及病原学比较

Comparisons on clinical manifestation and pathogen spectrum of sepsis between full-term and premature neonates of 38 cases

目的:研究新生儿败血症病例的临床表现、病原菌分布及菌株耐药状况。方法:回顾2011年10月至2014年2月收治的38例足月及早产新生儿败血症病例的临床和病原学资料并进行对比分析。结果:18例足月儿败血症病例中,10例为革兰阳性球菌所致,其中耐苯唑西林8例(8/10),临床多为晚发型(9/10),无院内感染;8例足月儿革兰阴性杆菌有6例为院内感染。20例早产儿败血症病例中,17例病原是革兰阴性杆菌,以大肠埃希菌、肺炎克雷伯杆菌及阴沟肠杆菌为主(16/17),临床多为早发型(11/20),院内感染9例(9/20)。革兰阳性菌对青霉素G、甲氧西林的耐药率接近或超过70%,均对万古霉素敏感;革兰阴性菌对阿莫西林耐药率95.8%,接近或超过70%对哌拉西林/他唑巴坦等含酶抑制剂敏感,对碳青霉烯类及氨基糖甙类100%敏感。结论:本院收治的足月新生儿败血症主要由革兰阳性菌感染所致,病原对苯唑西林耐药率高;早产败血症患儿主要由革兰阴性菌所致,分离株均对碳青霉烯类和氨基糖甙类敏感。

Objective To investigate the clinical manifestations and pathogen distribution of the neonatal sepsis, and to analyze the antibiotic resistance of the pathogens. Methods Review the Medical records of 38 sepsis cases of full-term and premature neonates in our hospital from October 2011 to February 2014 were collected and analyzed. Results Ten cases were caused by Gram-positive bacteria among the 18 full-term neonates with sepsis. Eight of ten of the isolates were resistant to oxcillin. Nine of ten of the cases were belonged to late onset infection, and the cases with no nosocomial infection were found. In the other eight full-term neonatal cases caused by Gram-negative bacteria, six cases were nosocomial infection. Among the 20 premature neonates with sepsis, 17 cases were infected Gram-negative bacteria, in which Escherichia coli, Klebsiella pneumonia and Enterobacter cloacae were the most common agents（16/17）. Early onset type and nosocomial infection were identified for 11（11/20） and 9（9/20） cases in the premature neonates, respectively. The penicillin G, methicillin resistant rates of the Gram-positive bacteria were close to or over 70%. All the Gram-positive bacteria were sensitive to vancomycin. All the Gram-negative bacteria were resistant to amoxicillin, but over 60% of them were sensitive to piperacillin-tazobactam and other compounds containing enzyme inhibitor, and 100% of them were sensitive to carbapenems and aminoglycoside. Conclusion The full-term neonatal sepsis admitted into our hospital were mainly caused by Gram-positive bacteria, which were usually resistant to oxcillin. The premature sepsis were mainly caused by Gram-negative bacteria, which were always sensitive to carbapenems and aminoglycoside.