新生儿窒息并发感染性肺炎的病原菌特点与影响因素分析

Pathogen characteristics and influencing factors of neonatal asphyxia complicated with infectious pneumonia

目的探讨新生儿窒息并发感染性肺炎的病原菌特点与影响因素。方法回顾性分析2015年3月-2017年8月海南省人民医院收治的998例窒息新生儿的临床资料,采集痰液标本进行培养鉴定,对发生感染性肺炎患儿的病原菌进行分析,分析患儿性别、胎龄、出生体质量等临床资料,归纳新生儿窒息并发感染性肺炎的影响因素。结果998例窒息新生儿中,共有102例并发感染性肺炎,感染率为10.22%;共培养分离病原菌131株,其中革兰阴性菌78株占59.54%,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌49株占37.40%,以金黄色葡萄球菌为主;真菌4株占3.05%;主要革兰阴性菌对头孢替坦、亚胺培南、美罗培南较敏感,主要革兰阳性菌对左氧氟沙星和万古霉素较敏感。羊水污染、胎膜早破、出生体质量及Apgar评分是新生儿窒息并发感染性肺炎的影响因素(P<0.05)。结论新生儿窒息并发感染性肺炎通常以革兰阴性菌为主。通过加强新生儿护理和肺炎防治,增加营养供应并对周围环境进行有效的消毒与隔离,指导产妇合理膳食,做好产前检查,并制定合理的分娩方案和加强产程监护,进而降低新生儿窒息与感染的风险。

OBJECTIVE To investigate the pathogen characteristics and risk factors of neonatal asphyxia complicated with infectious pneumonia.METHODS The clinical parameters of 998 asphyxia neonates admitted to our hospital from Mar.2015 to Aug.2017 were retrospectively analyzed.Sputum specimens were collected for culture identification and the pathogenic characteristics of the infected children were analyzed.The clinical parameters of children patients including gender,gestational age and birth quality were analyzed and the influencing factors of neonatal asphyxia complicated with infectious pneumonia were summarized.RESULTS Among 998 asphyxia neonates,102 cases had concurrent infectious pneumonia,the infection rate was 10.22%;131 strains of pathogens were isolated and co-cultured,of which 78 strains of Gram-negative bacteria accounting for 59.54%,dominated with Escherichia coli and Klebsiella pneumoniae;49 strains of Gram-positive bacteria accounting for 37.40%,dominated with Staphylococcus aureus;4 strains of fungi accounted for 3.05%.The dominated Gram-negative bacteria were mainly sensitive to cefotetan,imipenem,and meropenem,while the dominated Gram-positive bacteria were mainly sensitive to levofloxacin and vancomycin.Univariate analysis combined with multivariate logistic analysis showed that amniotic fluid contamination,premature rupture of membranes,birth quality,and Apgar score were the independent risk factors for neonatal asphyxia complicated with infectious pneumonia.CONCLUSION Neonatal asphyxia complicated infectious pneumonia is usually dominated by Gram-negative bacteria.The risk of neonatal asphyxia and infection could be reduced through strengthening neonatal care and pneumonia prevention,increasing nutrient supply and effective disinfection and isolation of the surrounding environment,guiding maternal reasonable diet,doing prenatal checkups,and formulating a reasonable delivery plan and strengthening the monitoring of labor.