孕产妇与新生儿李斯特菌病26例临床分析

Clinical analysis of 26 cases of maternal or neonatal listeriosis

目的通过分析围产期孕妇及新生儿李斯特菌病的临床特点及抗生素治疗等,提高临床对本病的认识和重视。方法选取2011年10月至2018年5月在北京民航总医院、厦门弘爱医院、北京市通州区妇幼保健院、北京天坛医院、唐山市妇幼保健院、天水市第四人民医院等6家医院诊断的李斯特菌病孕妇16例,以及2016年2月至2018年4月在天水市第四人民医院、唐山市妇幼保健院、郑州儿童医院等3家医院诊断为李斯特菌病新生儿10例,对其临床特点及药敏结果等进行回顾性分析。采用描述性方法对数据进行分析。结果(1)16例孕产妇中,其中1例孕早期发病,5例孕中期,10例孕晚期;8例有妊娠期合并症。16例孕期均发热,体温(38.9±0.5)℃;6例以咳嗽、鼻塞、流涕、咽痛、头晕头痛等流感样症状为主要临床表现,4例以流感样及胃肠道症状为主要临床表现。11例出现胎儿窘迫、心动过速、胎动减少。16例C-反应蛋白均升高;14例外周血白细胞计数升高。8例行胎盘病理学检查,均有中性粒细胞浸润、急性绒毛膜炎、炎性坏死等不同程度病理改变。16例初始治疗多以头孢菌素类为主,其中仅4例抗生素经验治疗覆盖了李斯特菌。16例中,仅有2例足月分娩,另14例发生流产、早产、死胎等不良妊娠结局。(2)10例新生儿中,早发型感染8例、晚发型感染2例;10例均发热,体温(38.6±0.6)℃,以发绀、呻吟、吐沫、三凹征为主要表现6例,呼吸急促5例,脑膜炎1例,皮肤红疹1例;外周血白细胞计数及C-反应蛋白均增高。初始经验治疗时,6例覆盖李斯特菌,另4例单独使用头孢菌素类抗生素患儿中,1例放弃治疗后死亡;8例调整用药为单独使用氨苄西林、青霉素、美罗培南、万古霉素,或氨苄西林联合美罗培南、万古霉素联合美罗培南,均治愈,另1例单独用美罗培南且未调整用药治愈。(3)药敏结果:青霉素、氨苄西林、美罗培南的敏感率为96.1%(25/26),复方新诺明的敏感率为88.5%(23/26)。结论围产期李斯特菌病母婴均无特异性临床表现。孕产妇起病急,不良妊娠结局发生率高。

Objective To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.Methods A retrospective analysis of 26 cases of listeriosis,including their demographic and clinical features,was conducted,involving 16 pregnant women from Civil Aviation General Hospital,Xiamen Humanity Hospital,Tongzhou Maternal and Child Health Hospital of Beijing,Beijing Tiantan Hospital,Tangshan Maternal and Child Health Hospital,the Fourth Hospital of Tianshui City from October,2011 to May,2018,and 10 newborns from the Fourth Hospital of Tianshui City,Tangshan Maternal and Child Health Hospital,Zhengzhou Children's Hospital from February,2016 to April 2018.Descriptive methods were used for data analysis.Results(1)Among the 16 gravidas,one,five and 10 developed the infection in the 1st,2nd and 3rd trimester of pregnancy,respectively,and eight had pregnancy complications.Furthermore,all of them developed fever[(38.9±0.5)℃].Symptoms such as cough,nasal congestion,runny nose,sore throat,dizziness,headache and other flu-like symptoms were observed in six cases.Gastrointestinal symptoms and flu-like symptoms were presented in four.Fetal distress,tachycardia and decreased fetal movement occurred in 11 cases.Elevated C-reactive protein and white blood cell count were detected in 16 and 14,respectively.Eight underwent placental pathological examination which shown various degrees of pathological changes,including neutrophil infiltration,acute chorioamnionitis and inflammatory necrosis.The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes.Only two delivered at term,while the others(14/16)ended in miscarriage,premature delivery or stillbirth.(2)Among the 10 newborns with listeriosis,there were eight early-onset infections and two late-onset infections.All of them were febrile[(38.6±0.6)℃].Six had cyanosis,groaning,foaming and three concave sign;five showed shortness of breath;meningitis and skin rash were found in one,respectively.All had elevated white blood cell and C-reactive protein.Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment.Four were treated with cephalosporins alone,one of which died after the treatment was withdrawn.One was cured by initial treatment with meropenem alone,while eight recovered after adjustment of treatment with ampicillin,penicillin,meropenem,vancomycin alone,or meropenem combined with ampicillin or vancomycin.(3)The isolates that were susceptible to penicillin,ampicillin and meropenem accounted for 96.1%(25/26)all together and 88.5%(23/26)were susceptible to compound sulfamethoxazole.Conclusions There is no specific clinical manifestations of maternal or neonatal listeriosis.Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.