48例新生儿结肠炎患儿的发病因素和致病菌特点分析

Pathogenetic factors for colonitis in 48 neonates and distribution of pathogens

目的探讨新生儿结肠炎患儿的发病因素及病原菌分布特点,为临床诊疗提供依据。方法选取2015年5月-2017年12月于医院出生的新生儿共380例作为研究对象,其中有48例新生儿发生结肠炎,将其分为研究组;剩余332例未发生结肠炎新生儿分为对照组,分析探讨影响新生儿结肠炎发生的危险因素和培养呈阳性标本中致病菌特点。结果多因素分析显示产前应用糖皮质激素、败血症、感染性休克、新生儿未服用益生菌、早产是引发新生儿结肠炎的独立危险因素;48例结肠炎患者血液、腹水样本共培养出病原菌株70株,其中革兰阴性菌52株(74.29%),以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌所占比例最高;革兰阳性菌16株(22.86%),以金黄色葡萄球菌、屎肠球菌、粪肠球菌所占比例最高;真菌检出2株(2.86%),均为白假丝酵母。结论新生儿结肠炎的发病因素多且复杂,提前调查分析,并做好针对性预防工作可有效降低新生儿结肠炎发生率。

OBJECTIVE To explore the pathogenetic factors for colonitis in neonates and investigate the distribution of pathogens so as to provide guidance for clinical diagnosis and treatment. METHODS A total of 380 neonates who were born in the hospital from May 2015 to Dec 2017 were recruited as the study objects, 48 neonates who had colonitis were assigned as the study group, and the rest of 332 neonates who did not have colonitis were set as the control group. The risk factors for colonitis and distribution of pathogens isolated from positive specimens were observed. RESULTS Multivariate analysis showed that use of glucocorticoids during prenatal period, sepsis, septic shock, without administration of probiotics by neonates and premature birth were the independent risk factors for the colonitis in the neonates. Totally 70 strains of pathogens were isolated from the blood and ascites specimens of 48 neonates with colonitis, 52(74.29%) of which were gram-negative bacteria, 16(22.86%) were gram-positive bacteria, and 2(2.86%) were fungi;Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the predominant species of the gram-negative bacteria;Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis were dominant among the gram-positive bacteria, and all of the isolated fungi were Candida albicans. CONCLUSION There are a variety of pathogenetic factors for the colonitis in the neonates, and it is an effective way to conduct the investigation and analysis in early stage and take targeted prevention measures so as to reduce the incidence of colonitis in the neonates.