新生儿晚发型败血症病原菌及诊断方法

Pathogens isolated from neonates with late-onset sepsis and diagnosis methods

目的探究血小板计数(PLT)、未成熟中性粒细胞/成熟中性粒细胞比值(I/T)、C-反应蛋白(CRP)联合用于新生儿晚发型败血症的诊断价值。方法选择2015年3月-2019年5月上饶市人民医院收治的80例败血症晚发型足月新生儿及100例住院非感染新生儿作为研究对象,分别为败血症组及对照组。采集败血症患儿血标本进行病原菌检测及耐药性分析,测定两组患儿PLT、I/T、CRP水平,分析单独或联合检测诊断败血症的临床价值。结果80例败血症患儿血培养共分离出82株病原菌,其中包括革兰阳性菌48株占58.54%,革兰阴性菌33株占40.24%,真菌1株占1.22%。革兰阴性菌中大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南等抗菌药物耐药率较低;革兰阳性菌中表皮葡萄球菌、溶血性葡萄球菌对万古霉素、利福平等抗菌药物耐药率较低。与对照组比较,败血症组患儿PLT计数显著降低,I/T比值及CRP水平均显著升高,两组比较差异有统计学意义(P<0.05)。PLT计数、I/T比值、CRP水平诊断新生儿败血症的曲线下面积分别为0.750、0.667、0.718。3种指标联合检测诊断曲线下面积为0.842,均高于两指标联合及单独检测。结论晚发型败血症患儿血培养检出病原菌以革兰阳性菌为主,PLT计数、I/T、CRP指标联合检测诊断价值优于单一指标。

OBJECTIVE To explore the value of joint detection of platelet(PLT)count,immature neutrophils/total neutrophils(I/T)and C-reactive protein(CRP)in diagnosis of neonates with late-onset sepsis.METHODS Totally 80 full-term neonates with late-onset sepsis and 100 neonates without infection who were hospitalized in Shangrao People′s Hospital from Mar 2015 to May 2019 were recruited as the study objects and divided into the sepsis group and the control group.The blood specimens that were obtained from the children with sepsis were cultured,the drug resistance was analyzed,the levels of PLT,I/T and CRP were detected,and the clinical value of the single or joint detection of the indexes in diagnosis of sepsis was observed.RESULTS A total of 82 strains of pathogens were isolated from the blood specimens of the 80 children with sepsis,48(58.54%)of which were gram-positive bacteria,33(40.24%)were gram-negative bacteria,and 1(1.22%)was fungus.Among the gram-negative bacteria,the drug resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem and meropenem were low.Among the gram-positive bacteria,the drug resistance rates of Staphylococcus epidermidis and Staphylococcus hemolyticus to vancomycin and rifampicin were low.The PLT level of the sepsis group was significantly lower than that of the control group,the levels of I/T and CRP of the sepsis group were significantly higher than those of the control group(P<0.05).The areas under curve of the PLT,I/T and CRP were respectively 0.750,0.667 and 0.718 in diagnosis of the children with sepsis.The area under curve of the joint detection of the three indexes was 0.842,higher than that of the joint detection of two indexes or detection of single index.CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the blood specimens of the children with late-onset sepsis.The joint detection of PLT,I/T and CRP has higher diagnostic value than the detection of single index.