极低及超低体重儿迟发型败血症病原菌分布及其发生影响因素分析

Analysis of the distribution of late-onset sepsis pathogens and the influence factors of late-onset sepsis on very low and extremely low birth weight infants

目的分析极低及超低体重儿迟发型败血症(LOS)的病原菌分布及LOS发生的影响因素,为极低及超低体重儿LOS的临床治疗提供参考。方法回顾性分析2014年12月—2017年9月杭州市妇产科医院166例极低及超低体重儿的临床资料,根据LOS发生情况将其分为非LOS组(74例)和LOS组(92例),LOS组中临床诊断为LOS的新生儿55例,确诊37例,比较2组新生儿的临床特征及病死率,分析LOS组新生儿的病原菌分布情况,并采用二元Logistic回归分析影响LOS发生的主要因素。结果 2组的小于胎龄儿(SGA)、新生儿窒息、新生儿呼吸窘迫综合征(NRDS)、动脉导管未闭(PDA)、经外周静脉穿刺中心静脉置管(PICC)、机械通气、胎龄、体重、肠外营养持续时间及住院时间比较差异有统计学意义(P <0. 05);LOS组新生儿病死率为14. 13%(13/92),非LOS组新生儿病死率为4. 05%(3/74),2组间差异有统计学意义(均P <0. 05);LOS组新生儿的致病菌共45株,其中,革兰阳性菌占31. 11%(14/45),革兰阴性菌占62. 22%(28/45),真菌占6. 67%(3/45);二元Logistic回归分析显示,新生儿窒息、PICC、胎龄及肠外营养持续时间是极低及超低体重儿发生LOS的主要影响因素。结论革兰阴性菌是极低及超低体重儿LOS的常见病原菌,新生儿窒息、PICC、胎龄及肠外营养持续时间是极低及超低体重儿发生LOS的主要影响因素。

Objective To analyze the distribution of late-onset sepsis （LOS） pathogens and the influence factors of LOS on very low and extremely low birth weight infant, and to provide reference for the clinical treatment. Methods The clinical data of 166 cases of very low and extremely low birth weight infant in our hospital from December, 2014 to September, 2017 were retrospectively analyzed, and they were divided into non-LOS group （74 cases） and LOS group （92 cases ） according to the occurrence of LOS. In the LOS group, 55 cases was diagnosed LOS and 37 cases were confirmed. The clinical features and mortality were compared between the two groups. The distribution of pathogens in LOS group was analyzed, and the influencing factors of LOS were assessed by binary logistic analysis. Results There were significantly differences in the small for gestational age （SGA）, neonatal asphyxia, neonatal respiratory distress syndrome （NRDS）, patent ductus arteriosus （PDA）, peripherally inserted central catheter （PICC）, mechanical ventilation, gestational age, weight, duration of parenteral nutrition and hospital time between the two groups （ P 〈 0.05 ）. The rate of fatality in LOS group was 14.13% （13/92）, and the non-LOS group was 4.05% （3/74）, and there were significantly differences in the rate of fatality by comparison （ P 〈 0.05 ）. The pathogens of the children in LOS group were 45 strains, among which, the gram-positive bacteria accounted for 31.11% （ 14/45 ）, the gram-negative bacteria accounted for 62.22% （28/45）, and the fungi accounted for 6.67% （3/45）. The binary logistic analysis showed that the main influencing factors of LOS were the neonatal asphyxia, PICC, gestational age and duration of parenteral nutrition. Conclusion Gramnegative bacteria are common pathogenic bacteria of LOS on very low and extremely low birth weight infant, and the neonatal asphyxia, PICC, gestational age and duration of parenteral nutrition were the main influencing factors of LOS.