新生儿医院感染败血症病原菌类型与PCT、WBC和CRP的临床变化

Study on the types of pathogenic septicemia and clinical changes of PCT,WBC and CRP in neonatal hospital infection

目的探讨新生儿医院感染败血症病原菌类型与血清降钙素原(PCT)、白细胞(WBC)和C-反应蛋白(CRP)的临床变化特点。方法选取2016年10月至2018年10月苏州明基医院收治的330例住院新生儿作为研究对象,其中37例新生儿发生医院感染败血症(感染组),293例未发生医院感染败血症(未感染组)。同时选取上海交通大学医学院附属苏州九龙医院100名正常新生儿作为对照组。采集所有研究对象的血液,鉴定及分离培养病原菌,并进行药敏试验。评价PCT、WBC和CRP诊断败血症的准确性。结果 37例发生医院感染败血症患儿,共培养分离病原菌68株,其中革兰阴性菌15株占22.06%,以肺炎克雷伯菌为主;真菌20株占29.42%,以热带假丝酵母为主;革兰阳性菌33株占48.53%,以表皮葡萄球菌和溶血葡萄球菌为主,病原菌对抗生素具有耐药性,以红霉素和青霉素G最高。感染组患儿WBC、PCT和CRP水平均高于未感染组和对照组,差异有统计学意义(P<0.05);在不同的临界值中,以CRP>3 mg/L,PCT>1.5 ng/L,WBC升高为标准时,PCT和CRP诊断败血症的准确率较高;当两种或两种以上指标联合时,CRP+PCT诊断败血症的准确性最高。结论新生儿医院感染败血症病原菌以革兰阳性菌为主,PCT、WBC和CRP对诊断医院感染败血症具有一定价值。

Objective To investigate the types of pathogenic septic pathogens and clinical changes of serum procalcitonin(PCT),white blood cells(WBC)and C-reactive protein(CRP)in neonatal hospital infection. Methods A total of 330 hospitalized newborns in Suzhou Mingji Hospital from October 2016 to October 2018 were selected as the research objects,including 37 newborns with septicemia infection(infection group)and 293 newborns without septicemia infection(non infection group). 100 normal newborns in Suzhou Kowloon Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were also selected as the control group. The blood samples of all subjects were collected;pathogenic bacteria were identified and isolated,and drug sensitivity tests were performed. The accuracy of PCT,WBC and CRP in the diagnosis of septicemia were measured. Results Septicemia occurred in 37 cases of newborns with an infection rate of 11.21%. A total of 68 isolates of pathogenic bacteria were co-cultured;of which,15 Gram-negative bacteria accounted for 22.06%,mainly Klebsiella pneumoniae,and 20 fungi accounted for 29.42%,Candida tropicalis was predominated;33 cases of Gram-positive bacteria accounted for 48.53%,mainly Staphylococcus epidermidis and Staphylococcus hemolyticus. Pathogens were resistant to antibacterial drugs,with erythromycin and penicillin G being the highest. The WBC,PCT and CRP index levels of children in the infected group were higher than those in the uninfected group and the control group,and the differences were statistically significant(P<0.05). Among the different cut-off values,when CRP>3 mg/L,PCT>1.5 ng/L,and WBC increase as the standard,PCT and CRP had higher accuracy in diagnosing septicemia. When two or more indicators were combined,CRP+PCT had the highest accuracy in diagnosing septicemia. Conclusions Nosocomial septicemia pathogens in neonates were mainly Gram-positive bacteria. PCT,WBC and CRP had certain value in the diagnosis of septicemiain hospital infections.