早发型与晚发型大肠埃希菌败血症临床对比分析

Clinical comparison of early-onset and late-onset sepsis caused by Escherichia coli

目的对比分析新生儿早发型与晚发型大肠埃希菌败血症的临床特征及药物敏感性。方法回顾分析2000年9月—2017年5月137例住院大肠埃希菌败血症新生儿的临床资料。按发生败血症时间不同,将其分为早发组(生后72小时内发病)、晚发组(生后72小时后发病),比较分析两组情况。结果早发组74例、晚发组63例。早发组胎膜早破发生率高于晚发组(21.6%对7.9%),早发组更易发生凝血功能障碍(39.2%对17.5%)、颅内出血(37.8%对19.0%)、呼吸衰竭(29.7%对14.3%)、低血糖(16.2%对4.8%),差异均有统计学意义(P均<0.05)。两组间第三代头孢菌素、氨基糖苷类、喹诺酮类、碳青霉烯类抗生素敏感性比较,差异无统计学意义(P均>0.05),大肠埃希菌对氨苄青霉素耐药率高达70%,对除头孢他啶外的头孢菌素类抗生素也有较高的耐药率,而对含β-内酰胺酶抑制剂的抗生素的敏感率为71.8%~90.7%,对喹诺酮类抗菌药物、氨基糖苷类的敏感性均>70%,对碳青霉烯类抗生素敏感率高达97%。结论早发型大肠埃希菌败血症的新生儿较晚发型并发症更多。早发型与晚发型新生儿大肠埃希氏菌败血症药物敏感性无明显差异,大肠埃希菌败血症可首选含β-内酰胺酶抑制剂的抗生素,疗效不佳时可选用碳青霉烯类抗生素。

Objective To compare the clinical characteristics and drug susceptibility of neonatal early-onset sepsis(EOS)and late-onset sepsis(LOS)caused by Escherichia coli.Methods The clinical data of 137 neonates with Escherichia coli septicemia from September 2000 to May 2017 were retrospectively analyzed.All neonates were divided into EOS group(onset within 72 hours after birth)and LOS group(onset over 72 hours after birth)according to the time of sepsis,and the clinical data of two groups were compared.Results There were 74 cases in EOS group and 63 cases in LOS group.Compared with LOS group,infants in EOS group had higher incidence of premature rupture of membranes(21.6%vs.7.9%),and was more likely to have coagulation dysfunction(39.2%vs.17.5%),intracranial hemorrhage(37.8%vs.19%),respiratory failure(29.7%vs.14.3%),and hypoglycemia(16.2%vs.4.8%).The differences were statistically significant(all P<0.05).There was no difference in sensitivity to third-generation cephalosporins,aminoglycosides,quinolones and carbapenems antibiotics between the two groups(all P>0.05).The rate of Escherichia coli resistant to ampicillin was up to 70%,and the rate to cephalosporins except ceftazidime was also high.While the rate of Escherichia coli sensitive to antibiotics containingβ-lactamase inhibitors was 71.8%~90.7%,the rate to quinolones and aminoglycosides was over 70%,and the rate to carbopenems was up to 97%.Conclusion Neonates with early-onset Escherichia coli sepsis had more complications than those with late-onset sepsis.There was no difference in drug sensitivity between early-onset and late-onset neonatal Escherichia coli sepsis.Antibiotics containingβ-lactamase inhibitors should be the first choice in treatment of Escherichia coli sepsis,and carbapenems could be used if its efficacy is poor.