82例极低/超低出生体重儿败血症的临床分析

Cinical Analysis of 82 Cases of Very and Extremely Low Birth Weight Infants with Septicemia

目的:分析极低/超低出生体重儿败血症的临床特征、病原菌及药物敏感情况,为其早期诊断及治疗提供参考。方法:对2014年1月1日至2017年12月31日阜阳市人民医院新生儿重症监护病房(NICU)确诊的82例早产极低/超低出生体重儿败血症的临床表现、实验室检查、病原菌及药敏情况进行回顾性分析。结果:极低/超低出生体重儿败血症以早发型(≤7天)为主,晚发型以院内感染为主,临床表现缺乏特异性,实验室检查中白细胞、血小板出现减低,C反应蛋白和降钙素原增高。病原菌以革兰阴性菌为主,其次为革兰阳性菌和真菌。药敏结果显示革兰阴性菌对三代头孢、氨苄西林类抗生素100%耐药,对加他唑巴坦的抗生素耐药率较低,对碳氢酶烯类抗生素敏感。革兰阳性菌对β-内酰胺类、大环内酯类、氨基糖甙类及克林霉素等耐药率较高,对万古霉素、利奈唑烷敏感。82例败血症患儿中,死亡6例,死亡率为7.3%。结论:早产极低/超低出生体重儿败血症缺乏特异性临床表现,且发病率高,应密切观察患儿临床表现及动态监测其C反应蛋白、血小板等的变化,同时及时完善细菌培养及药敏试验,有效合理使用抗生素,以减少多重耐药菌株产生,改善患儿预后。

Objective：To analyze the clinical features,pathogens and their antimicrobial susceptibilities of neonatal septicemia in premature very and extremely low birth weight infants（VLBWI/ELBWI）,and provide appropriate guide for the early diagnosis and tratment.Methods：A retrospective review of 82 cases of neonatal septicemia in premature VLBWI/ELBWI admitted in the neonatal intensive care unit（NICU） of our hospital from Jan.1,2014 to Dec.31,2017 was conducted.The clinical features,examinations,distribution of pathogens and the antimicrobial susceptibilities were statistically analyzed.Results：The early onset septicemia（EONS） was dominant in VLBWI/ELBWI with septicemia.No socomial infection was commonly seen in late onset septicemia（LONS）.The clinical manifestations were non-specific.The WBC and platelet were significantly decreased,the CRP and PCT levels were significantly increased.Gram-negative bacteria were the main pathogens,and gram-positive bacteria and fungi were the second.Drug sensitivity test showed that the antibiotic resistance rates of gram-negative bacteria to three generation cephalosporin and penicillin were 100%,and the antibiotic resistance rate of tazobactam was lower.But they were completely sensitive to carbopenems.Gram-positive bacteria were highly resistant to beta lactams,macrolides,aminoglycosides and clindamycin,al,but sensitive to vancomycin and linezolid.Among those 82 cases,6 cases died.The mortality rate of neonatal septicemia in VLBWI/ELBWI was 7.3%.Conclusions：Premature VLBWI/ELBWI were susceptibility to septicemia,and the early manifestations were non-specific,so monitoring the clinical symptoms with dynamically detecting CRP and platelate were useful for the early diagnosis of premature septicemia.Meantime,appropriate use of antibiotics according to drug sensitivity were suggested to reduce the occurrence of multi-drug resistant bacteria prevent and to improve the prognosis.