不同病原菌所致早产儿败血症的临床特点分析

Clinical characteristics of preterm infants with septicemia caused by different pathogens

目的探讨革兰阳性(G+)菌、革兰阴性(G-)菌和真菌所致早产儿败血症的临床差异,为早产儿感染的识别和治疗提供依据。方法回顾性分析2014年1月至2018年5月郑州大学第三附属医院新生儿重症监护病房收治的早产儿败血症患儿临床资料,分析首次血培养病原菌构成,比较不同病原菌所致败血症的临床特征及预后。结果共纳入371例败血症早产儿,G^+菌组53例(14.3%),以表皮葡萄球菌和肠球菌为主;G^-菌组235例(63.3%),以肺炎克雷伯菌和大肠埃希菌为主;真菌组83例(22.4%),以白假丝酵母菌和热带假丝酵母菌为主。3组早产儿性别、胎龄、出生体重、分娩方式等比较差异无统计学意义(P>0.05);与G^+组[6.0(1.0,13.0)d]比较,G-组[17.0(9.0,27.0)d]和真菌组[18.0(12.8,30.3)d]发病日龄较晚;G-组感染前机械通气时间[1.0(0.0,3.0)d]较G+组[0.8(0.0,1.0)d]和真菌组[0.0(0.0,1.0)d]长,更易合并肺炎、支气管肺发育不良;与真菌组(15.7%,13/83)比较,G^+组(56.6%,30/53)和G^-组(34.0%,80/235)首发症状为呼吸困难比例较高,真菌组表现为腹胀的比例较高;真菌组起病时血小板计数[112.0(75.5,186.2)×10^9/L]较G-组[169.5(102.0,246.0)×10^9/L]和G+组[175.0(115.0,242.0)×10^9/L]低,感染前应用抗生素时间、深静脉置管时间更长,更易合并坏死性小肠结肠炎,差异均有统计学意义(P<0.05)。结论早产儿败血症病原菌以G-菌为主;不同病原菌所致早产儿败血症的临床特征存在差异;应结合临床特征推断可能病原菌,及早合理用药。

Objective To study the clinical characteristics and complications of septicemia caused by Gram-positive(G+)bacteria,Gram-negative(G-)bacteria and fungi in preterm infants to provide evidence for the diagnosis and treatment of premature infection.Method From January 2014 to May 2018,clinical data of premature infants with positive blood culture sepsis and admitted to our NICU were retrospectively analyzed.The compositions of the first-time detected pathogen were analyzed,and the clinical characteristics,complications and prognosis of sepsis caused by different pathogens were compared.Result Among the 371 strains of pathogen detected,53 strains(14.3%)were G+bacteria,mainly including staphylococcus epidermidis and enterococcus;235 strains(63.3%)were G-bacteria,mainly including klebsiella pneumoniae and escherichia coli;83 strains(22.4%)were fungi,mainly including candida albicans and candida tropicalis.No differences existed in gestational age,birth weight,gender and delivery mode among the three groups of premature infants(P>0.05).Compared with the G+group[6.0(1.0,13.0)d],the G-group[17.0(9.0,27.0)d]and the fungal group[18.0(12.8,30.3)d]had a later onset age(P<0.05).The G-group[1.0(0.0,3.0)d]had a longer duration of mechanical ventilation before infection than the G+group[0.8(0.0,1.0)d]and the fungal group[0.0(0.0,1.0)],and was more likely to have pneumonia and bronchopulmonary dysplasia(P<0.05).Compared with the fungal group(15.7%),the G+group(56.6%)and G-group(34.0%)were more likely to have dyspnea as the first presenting symptom(P<0.05).The fungal group was more likely to have abdominal distension as the first presenting symptom(P<0.05).The blood platelets count was lower in fungal group than G-group[112.0(75.5,186.2)×109/L vs.169.5(102.0,246.0)×109/L]and G+group[175.0(115.0,242.0)×109/L]at the onset of the disease.The fungal group had longer duration of antibiotics and deep vein catheterization,and was more likely to have necrotizing enterocolitis(P<0.05).Conclusion The pathogen of preterm sepsis are mainly G-bacteria.Different pathogens has different clinical features.Based on the clinical features,possible pathogens can be suspected for rational and early use of antibiotics.