新生儿败血症的临床特征及病原学特征分析

Clinical characteristics and etiological characteristics of neonatal sepsis

目的探讨新生儿败血症的临床特征、危险因素、病原菌分布及耐药状况,为指导临床诊断及治疗新生儿败血症提供参考。方法回顾性分析2015年至2018年青岛市妇女儿童医院收治的新生儿败血症患儿(败血症组120例)的临床资料,并与同期收治的新生儿普通感染患儿(普通感染组100例)进行比较,通过多因素Logistic回归分析新生儿败血症的危险因素;同时,分析导致败血症患儿的病原菌及不同病原菌的临床特点。结果败血症组患儿的发病时间多在生后1~7天(χ^(2)=6.43),住院天数较长(χ^(2)=7.63),感染指标中的外周血白细胞(WBC)升高比例(χ^(2)=20.92)、白介素(IL)-10水平(t=25.28)、CD64水平(t=12.75)变化显著,合并化脓性脑膜炎(χ^(2)=4.95)及胎膜早破>18小时者较多(χ^(2)=10.31),与普通感染组比较差异均有统计学意义(P<0.05)。经Logistic回归分析显示,IL-10水平(OR=5.77,95%CI:1.73~19.26)和胎膜早破>18小时(OR=4.10,95%CI:1.27~13.22)是新生儿败血症发病的高危因素(P<0.05)。败血症组患儿的血培养均为阳性,共检出11种细菌,其中革兰氏阳性菌66株,以表皮葡萄球菌、无乳链球菌和屎肠球菌为主;革兰氏阴性菌56株,以大肠埃希菌、阴沟肠杆菌和克雷白菌属为主。药敏结果显示,主要革兰氏阳性菌普遍对青霉素、红霉素耐药率高,而对万古霉素及利奈唑胺均未出现耐药;革兰氏阴性菌对头孢曲松的耐药率较高,但对亚胺培南和美罗培南均未出现耐药。不同病原菌所致的病情存在差异,其中无乳链球菌和大肠埃希菌感染者发病时间早、住院时间长、容易合并化脓性脑膜炎。在感染指标中,大肠埃希菌感染后IL-10水平高。结论胎膜早破>18小时和IL-10水平升高为新生儿败血症的高危因素,应针对危险因素尽早实施干预治疗,结合患儿临床表现和药敏结果选用药物,指导临床治疗。

Objective To provide reference for clinical diagnosis and treatment of neonatal sepsis by analyzing the clinical characteristics,risk factors,pathogenic bacteria distribution and drug resistance of neonatal sepsis.Methods The clinical data of 120 cases of neonatal sepsis(septicemia group)admitted to Qingdao Women and Children′s Hospital from 2015 to 2018 was retrospectively analyzed,and they were compared with 100 cases of common infection patients admitted during the same period(common infection group).The risk factors of sepsis were analyzed by multivariate Logistic regression analysis.At the same time,the pathogenic bacteria were analyzed to find out the clinical characteristics of different pathogenic bacteria.Results The onset time of children in the septicemia group was mostly 1 to 7 days after birth(χ^(2)=6.43),and the length of hospital stay was longer(χ^(2)=7.63).In the infection indicators of the septicemia group,the increased proportion of peripheral blood white blood cells(WBC)(χ^(2)=20.92),interleukin(IL)-10 levels(t=25.28),and CD64 levels(t=12.75)changed significantly,with purulent meningitis(χ^(2)=4.95)and premature rupture of membranes>18 hours(χ^(2)=8.18),and the difference was statistically significant compared with the common infection group(P<0.05).Logistic regression analysis showed that IL-10 level(OR=5.77,95%CI:1.73-19.26)and premature rupture of membranes>18 hours(OR=4.10,95%CI:1.27-13.22)were the high-risk factors for onset of neonatal sepsis(P<0.05).In the septicemia group,all the blood cultures were positive,and 11 kinds of bacteria were detected,among which 66 strains were Gram-positive bacteria,including Staphylococcus epidermidis,Streptococcus agalactiae and Enterococcus faecium,56 strains were Gram-negative bacteria,including Escherichia coli,Enterobacter cloacae and Klebsiella.Drug susceptibility results indicated that the main Gram-positive bacteria were generally resistant to penicillin and erythromycin,but no resistance to vancomycin and linezolid.The resistance rate of Gram-negative bacteria to ceftriaxone was higher,but there was no resistance to imipenem and meropenem.There were differences among different pathogenic bacteria.Streptococcus agalactiae and Escherichia coli infected patients had early onset,long hospitalization time and were easy to be complicated with purulent meningitis.Among the infection indicators,the level of IL-10 was higher after E.coli infection than other kinds of bacteria.Conclusion Premature rupture of membranes more than 18 hours and elevated IL-10 level are high-risk factors for neonatal sepsis.Interventions and treatments should be carried out as soon as possible.Drugs should be selected according to the clinical manifestations and drug sensitivity results.