新生儿单核细胞增生李斯特菌败血症1例

Listeria monocytogenes blood flow sepsis in 1 infants

目的探讨医院收治的新生儿单核细胞增生李斯特菌(LM)感染临床诊治策略。方法回顾性分析河北生殖妇产医院2019年11月1例LM血流感染孕妇娩出新生儿的临床资料,采用描述性方法对新生儿的病情、生化检验结果及影像学资料进行分析总结。结果孕妇入院诊断为LM血流感染,分娩新生儿入住新生儿科诊断为呼吸窘迫综合征,血培养、脑脊液培养鉴定为LM感染。新生儿定期复查血常规及其他生化指标,外周血白细胞计数、淋巴细胞、生化指标等随治疗进展呈动态变化。主要治疗方案为抗菌药物、呼吸支持、丙种球蛋白提高免疫、营养支持、脏器功能维护、稳定内环境及密切护理等。经一个月治疗后患儿血细胞分析大致正常,纠正贫血后离氧,一般情况良好,自主生活能力明显提高,无感染迹象,安排出院并要求定期复查,预后良好。LM对常用于细菌性脑膜炎经验性治疗的三代头孢天然耐药,治疗上敏感抗菌药物为氨苄青霉素、美罗培南、磺胺甲噁唑/甲氧苄啶,此外青霉素、红霉素、氨基糖苷类亦有效。结论新生儿李斯特菌感染为新生儿早期严重感染性疾病,早发型多见,并发症多,病死率高,患儿母亲多合并有高危因素,对该类患儿应尽早行微生物检查明确诊断,选用抗菌药物时需注意兼顾LM感染的可能性,从而降低病死率,改善预后。

OBJECTIVE To explore the clinical diagnosis and treatment strategy of Listeria monocytogenes(LM) infection in neonates admitted to the hospital. METHODS A retrospective analysis was made of The clinical data of a pregnant woman with LM bloodstream infection who delivered a newborn in Hebei Reproductive and Obstetrics Hospital in November 2019 were retrospectively analyzed. Descriptive methods were used to analyze and summarize the condition, biochemical test results and imaging data of the newborn.RESULTS Pregnant women were diagnosed with LM infection on admission. The newborn infant was admitted to the neonatal department and diagnosed as respiratory distress syndrome. Blood culture and cerebrospinal fluid culture were identified as LM infection. The blood routines and other biochemical indicators of newborn were checked regularly. The peripheral blood white blood cell count, lymphocytes and biochemical index showed dynamic changes as the treatment progress. The main treatment regimens were antibacterial drugs, respiratory support, improvement of immunity by gamma globulin, nutritional support, maintenance of organ function, stable internal environment and close care, etc. After one month of treatment, the blood cell analysis of the child was generally normal. After anemia was corrected, the patient was deoxygenated and in good general condition, with significantly improved ability to live independently and no signs of infection. The patient was discharged from the hospital, required regular review and with a good prognosis. LM is naturally resistant to the third-generation cephalosporin commonly used in the empirical treatment of bacterial meningitis. The therapeutically sensitive antibiotics were ampicillin, meropenem, sulfamethoxazole/trimethoprim, and penicillin, erythromycin, aminoglycoside were also effective. CONCLUSION Neonatal Listeria infection was a serious infectious disease in the early stage of the newborn. Early onset was more common, with many complications, and high mortality. The mothers of these neonates were often with high risk factors. Microbiological examination should be performed as early as possible to confirm the diagnosis of such children, and attention should be paid to the possibility of Listeria infection when choosing the antibiotics, so as to reduce the mortality and improve the prognosis.