新生儿咽部细菌定植的临床分析

Clinical analysis of throat swab culture in neonates

目的通过对新生儿入院24h内咽拭子培养结果及其临床资料进行分析,探讨咽部细菌定植在新生儿感染中的临床意义。方法选择2011年1月至2014年6月于四川省人民医院(城东病区)住院治疗的934例新生儿为研究对象,其中男性新生儿为527例,女性为407例。本研究纳入标准:临床资料完整的住院新生儿;排除标准:临床资料不完整及自动出院者。所有受试者均于入院24h内即行咽拭子培养,并收集新生儿一般资料,分析新生儿细菌定植和致病菌感染情况、胎膜早破(PROM)与新生儿感染的关系,以及早产儿、足月儿细菌定植与感染的关系。本研究遵循的程序符合四川省人民医院(城东病区)人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试者监护人的知情同意。结果 12011-2014年934例新生儿的咽拭子培养检查结果中,混合菌群为487份(52.1%),单一菌(致病菌)为259份(27.7%),培养结果呈阴性为188份(20.1%)。934例新生儿咽拭子培养中,致病菌中所占比例最高的前5种细菌分别为表皮葡萄球菌为43株(16.6%)、副流感嗜血杆菌为26株(10.0%)、流感嗜血杆菌为26株(10.0%)、肺炎克雷伯菌为21株(8.1%)、大肠埃希菌为19株(7.3%)。2母亲出现PROM新生儿的呼吸道感染发生率(96.7%)与未出现PROM者(85.6%)比较,差异有统计学意义(χ~2=5.692,P=0.013)。PROM时间>24h新生儿的咽拭子培养呈阳性者的感染率(70.0%)高于未出现PROM者(50.7%),并且差异有统计学意义(χ~2=6.685,P=0.013)。3早产儿咽拭子培养呈阳性者为92例(55.8%),足月儿咽拭子培养呈阳性者为654例(85.0%)。足月儿咽拭子培养阳性率及咽拭子培养呈阳性合并感染率均显著高于早产儿(85.0%vs 55.8%,53.5%vs 37.0%),二者比较,差异有统计学意义(χ~2=72.453,P<0.001;χ~2=8.855,P=0.004,)。此外,早产儿和足月儿咽拭子培养结果示混合菌、单一菌所占比例比较,差异有统计学意义(χ~2=16.975、55.107,P<0.001)。结论新生儿入院24h内进行咽拭子培养,尤其对于母亲出现PROM的新生儿,可及时掌握细菌定植情况,采取合理的干预措施。

Objective To study the clinical significance of bacterial colonization in neonatal infection through intergrating the throat swab culture and other clinical data in admitted neonates within 24 hours. Methods The clinical data of 934 newborns （527 boys and 407 girls） who were admitted to Sichuan Provincial People＇s Hospital （East Region） from January 2011 to June 2014 were analyzed retrospectively. Inclusion criteria of this study were hospitalized neonates with complete clinical data, and the exclusion criteria were neonates without complete clinical data and automatic discharge. All of them were taken throat swab culture once during 24 hours after admission. The bacterial colonization, relationship between premature rupture of membranes （PROM） and neonatal infection, relationship between preterm and full-term neonates and infection were detected. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Sichuan Provincial Peoplers Hospital （East Region）. Results Four hundreds and eight-seven samples （52, 1~） showed normal mixed bacteria, 259 samples （27.7~） were pathogenic bacteria, another 188 samples （20. 1%） were negative in 934 throat swab culture results from 2011 to 2014. Top 5 pathogenic bacteria were Staphylococcus epidermidis （43 strains, 16. 6%）, Hemophilus parainfluenzae （26 strains, 10. 0%）, Hemophilus influenzae （2t strains, 10. 0%）, Pneumonia kleiber （21 strains, 8. 1%） and Escherichia coli （19 strains, 7. 3%） in 4 years. QThere was statistical significance between respiratory tract infection rates in neonates with PROM （96.7 %） and non-PROM cases （85.6%） （;（2 =5. 692, P=0.01a）. Throat swab culture positive in neonates with PROM〉-24 hours （70.0%） was higher than that in non-PROM term （50.7%）, which had statistical significance （;（2=6. 685,P=0. 013）. Ninety-two cases（55.8%） who received throat swab culture showed positive in premature infants, and 654 cases （85.0%） showed positive in full-term infants. The positive rate of throat swab culture and positive rate of throat swab culture combined with infection of full-term neonates were higher than those of preterm neonates （85.0 % vs 55.8 %, 53.5 % vs a7.0%〉, which ha＇d significant differences （;（2 = 72. 453, 8. 855;P〈0.05）. Besides, there was statistical significance between premature and full-term infants in throat swab culture comparing mixed and single bacteria test （;（2 =16. 975, 55. 107~ P^0. 001）. Conclusions Throat swab culture can be useful in identifying bacterial colonization during 24 hours after admission, especially for those with PROM.