新生儿无乳链球菌败血症临床分析

Clinical analysis of neonatal septicemia caused by Streptococcus agalactiae

目的探讨新生儿无乳链球菌败血症的临床特点、治疗及预后。方法选取2017年1月至2019年12月我院收治的29例新生儿无乳链球菌败血症病例,根据发病时间分为早发型组(≤7 d)和晚发型组(>7 d),回顾性分析患儿相关资料。结果29例新生儿无乳链球菌败血症占同期所有新生儿败血症的10.8%。阴道分娩23例(79.3%),剖宫产6例(20.7%);早发型组18例(62.1%),晚发型组11例(37.9%)。早发型组合并肺炎的比例高于晚发型组(83.3%比36.4%),合并化脓性脑膜炎的比例低于晚发型组(33.3%比81.8%),住院天数少于晚发型组[(16.17±9.33)d比(36.73±27.43)d](P均<0.05)。外周血白细胞升高9例(31.0%),降低15例(51.7%),C-反应蛋白升高18例(62.1%),降钙素原均高于正常。所检菌株对青霉素、氨苄西林、万古霉素、利奈唑胺及头孢噻肟的敏感率100%,对红霉素、克林霉素、四环素的敏感率分别为30.0%、31.0%、24.1%。28例患儿为两种抗生素联合抗感染治疗。治愈22例(75.9%),好转出院3例(10.3%),放弃治疗死亡4例(13.8%),1例遗留神经系统后遗症。结论无乳链球菌是新生儿败血症的常见病原菌之一,不同发病时间患儿合并症不同。外周血白细胞降低、降钙素原升高在新生儿无乳链球菌败血症感染中敏感性较高。青霉素和(或)头孢类抗生素为首选药物,危重者采用两种抗生素联合治疗。

Objective To explore the clinical characteristics,treatment and prognosis of neonatal septicemia caused by Streptococcus agalactiae.Methods There were 29 cases of neonatal septicemia caused by Streptococcus agalactiae from January 2017 to December 2019 treated at Qingdao Women and Children′s Hospital.These cases were divided into the early-onset group(onset day of the patients≤7 d)and late-onset group(onset day of the patients>7 d).Clinical data were collected for analysis.Results The cases included in the current study accounted for 10.8%of all neonatal septicaemia during the same period.There were 23 cases born via vaginal delivery(79.3%)and 6 cases born by cesarean section(20.7%).Eighteen cases(62.1%)had early-onset(≤7 d)sepsis,and eleven cases(37.9%)had late-onset(>7 d)sepsis.The incidence of pneumonia was higher in the early-onset group compared with the late-onset group(83.3%vs.36.4%),while the incidence of purulent meningitis in early-onset group was lower than that in the late-onset group(33.3%vs.81.8%),and the length of hospital stay was shorter in early-onset group[(16.17±9.33)d vs.(36.73±27.43)d].The differences between two groups were statistically significant(all P<0.05).Peripheral white blood cell counts elevated in 9(31.0%)cases,and reduced in 15(51.7%)cases.The levels of C-reactive protein increased in 18(62.1%)cases,while the early value of procalcitonin increased in all cases.Drug sensitivity test showed that the sensitivity rates to erythromycin,clindamycin and tetracycline were 30.0%,31.0%,and 24.1%,respectively.All strains were sensitive to penicillin G,ampicillin,vancomycin,linezolid and cefotaxime.A total of 28 cases were treated with two antibiotics.Twenty-two cases(75.9%)were cured,three cases(10.3%)were discharged after improvement,four cases(13.8%)died after abandoning treatment,and one case was left with neurological sequelae.Conclusion Streptococcus agalactiae is one of the common pathogens of neonatal septicemia.Children with different onset time may have different complications.Decrease in white blood cell counts and elevation of procalcitonin are highly sensitive to neonatal septicaemia caused by Streptococcus agalactiae.Penicillin and/or cephalosporin antibiotics are the first choice in treatment,and the critically ill patients are treated with combination of two antibiotics.