新生儿李斯特菌败血症临床分析

Clinical analysis of Listeria sepsis in newborns

目的探讨新生儿李斯特菌败血症的临床特点及诊疗方法，提高对李斯特菌败血症的认识，降低病死率。方法回顾性分析2014年1月至2018年3月于我院新生儿科住院的22例经血培养确诊为新生儿李斯特菌败血症患儿的临床资料，对其临床特点、辅助检查、药敏试验结果、治疗方法及预后进行分析研究。结果临床特点主要表现为呼吸困难15例、发热3例、抽搐3例，合并化脓性脑膜炎10例，肺炎3例，休克2例，新生儿坏死性小肠结肠炎1例。生化检查示白细胞计数升高7例，降低5例，C反应蛋白升高21例。头MⅪ示颅内出血6例，脑白质损伤5例，脑积水1例。药敏试验显示，李斯特菌对复方新诺明、青霉素G和氨苄西林敏感率最高。治愈10例，好转6例，死亡6例。结论新生儿李斯特菌败血症是新生儿期较严重的感染性疾病，识别其早期症状，尽早行病原学诊断和有效治疗，有助于改善预后，降低病死率。

bjective To explore the clinical features and discuss the diagnosis and treatment of neonatal sepsis caused by Lesteria. Methods We collected 22 newborn cases of Listeriosis admitted in neonatal intensive care unit from January 2014 to March 2018. The diagnosis of Listerosis was confirmed by blood culture. The clinical features, assistant examination results, drug sensitivity test and therapeutic effect were analyzed. The prognosis of Listeria sepsis was traced. Results Clinical features included dyspnea （ 15 cases）, fever （ 3 cases）, convulsion （ 3 cases）. Ten cases complicated purulent meningitis, 3 cases com- plicated pneumonia and 2 cases complicated shock, 1 case complicated with neonatal necrotizing enterocolitis. Laboratory findings showed that white blood cell count （ 〉 25×10^9/L） increased in 7 cases ,decreased （ 〈 5×10^9/L） in 5 cases, and C-reactive protein elevated in 21 cases. Head MRI showed intracranial hemorrhage （6 cases） ,neonatal white matter injury （5 cases） and hydrocephalus （1 case）. Drug sensitivity test showed that Lesteria were sensitive to sulfamethoxazole, penicillin and ampicillin. Ten cases were cured, 6 cases improved,and 6 cases died. Conclusion Neonatal Listeria sepsis is a serious infectious disease. It is very important to recognize its early symptoms. Early detection of pathogens and targeted treatment can help improve prognosis and reduce mortality.