新生儿泌尿道感染早期临床表现及病原学分析

Early clinical manifestation and etiological analysis of neonatal urinary tract infection

目的通过对新生儿泌尿道感染的早期临床表现、经验性抗生素选择及病原学分析的探讨,总结如何尽早识别新生儿泌尿道感染及早期合理选择抗生素的目的。方法回顾性分析我院2017年1月至2018年10月新生儿科病房收治的新生儿泌尿道感染43例临床资料,对入组患儿主诉、入院24 h内血常规、尿常规、经验性抗生素选择及中段尿培养病原菌、药敏试验结果及住院时间、病情转归等资料进行分析、总结。结果该组研究中女性患儿22例,男性患儿21例,男女发病率无明显差异,主要临床表现是皮肤黄染15例、发热14例、青紫和腹胀各3例等,其中发热>38℃13例,黄疸持续时间延长>15 d 3例或者黄疸出现时间推后>7 d 10例;中段尿培养阳性7例。血常规及C反应蛋白、降钙素原指标不均一,但中段尿培养阳性者通常会伴随典型症状或者严重感染阳性指标,病原菌以大肠埃希菌最常见占71.4%(5/7),对阿莫西林克拉维酸钾、美罗培南、左氧氟沙星100%敏感,对氨苄西林、头孢唑啉、派拉西林等耐药性高(80%),对常用抗生素头孢曲松及头孢他啶的耐药率是40%和20%。结论新生儿泌尿系感染临床表现缺乏特征性,以全身症状为主,发热及黄疸持续时间延长或出现时间推后者需尽快完善尿常规及中段尿培养;血常规+C反应蛋白及降钙素原等指标不能作为尿道感染的诊断指标,但可提示病情的轻重程度;阳性病原菌主要是革兰阴性杆菌,以大肠埃希菌为主,耐药性高。

Objective To explore the early clinical manifestations,empirical selection of antibiotics,and etiological analysis of neonatal urinary tract infection,and to summarize how to identify neonatal urinary tract infection as early as possible and how to select antibiotics reasonably in the early stage.Methods The clinical data of 43 neonates diagnosed with neonatal urinary tract infection in neonatal ward of our hospital from January 2017 to October 2018 were retrospectively analyzed.The main complaints,blood routine and urine routine within 24h of admission,empirical selection of antibiotics,mid-stream urine culture pathogen,drug susceptibility test,hospitalization time,and prognosis of neonatal urinary tract infection were collected for analysis and summary.Results There were 22 cases of female children and 21 cases of male children in the study.There was no significant difference in the incidence between the male and female.The main clinical manifestations were jaundice(15 cases),fever(14 cases),cyanosis and abdominal distention(3 cases each).Among them,fever was more than 38 degrees in 13 cases,jaundice duration was prolonged to more than 15 days in 3 cases,or jaundice occurrence time was delayed over 7 days in 10 cases.Urine culture was positive in 7 cases.The blood routine and CRP and PCT indices were not uniform,but the patients with positive mid-stream urine culture usually had typical symptoms or positive indexes for severe infection.Escherichia coli was the most common pathogen(71.4%,5/7),which was 100%sensitive to amoxicillin,clavulanate,meropenem and levofloxacin.It was highly resistant to ampicillin,cefazolin and paracillin(80%).It was also resistant to common antibiotics.The resistance rates to ceftriaxone and ceftazidime were 40%and 20%.Conclusion The clinical manifestations of neonatal urinary tract infection are in lack of characteristics,and the main symptoms are systemic symptoms.The patients with prolongation of fever and jaundice or the delayed occurrence of jaundice need to complete urinary routine and mid-stream urine culture as soon as possible;blood routine+CRP and PCT can not be used as diagnostic indicators of urinary tract infections,but can indicate the severity of the disease;the positive pathogens are mostly Gram-negative bacilli,mainly Escherichia coli.The drug resistance rate is high.