早产儿李斯特菌败血症临床特征及治疗分析

Clinical characteristics and treatment of listeriosis in premature infant

目的了解早产儿单核细胞增生性李斯特菌(LM)败血症的临床特点,为该病的临床诊治提供参考。方法回顾性分析2011年1月至2020年10月苏州大学附属儿童医院新生儿科收治的血培养为LM的早产儿临床资料。结果14例早产患儿中男9例、女5例,胎龄中位数为32.4周(30.4~34.1周);出生体质量中位数为1885g(1513~2188g)。产妇临床症状以产前发热、流感样症状、不规则腹痛常见,发病季节以春季和夏季较多;感染的早产儿围产期发生宫内窘迫12例(85.71%)、窒息12例(85.71%)、羊水污染11例(78.57%),生后表现为发热或体温不升11例(78.57%)、气促呻吟13例(92.86%)、皮肤出现黄疸6例(42.86%)及皮疹8例(57.14%);主要并发症为新生儿肺炎、呼吸窘迫综合征、感染性休克、化脓性脑膜炎、颅内出血。实验室检查:7例(50%)患儿白细胞计数明显升高(>25×10^(9)/L),2例(14.29%)明显降低(<5×10^(9)/L);血小板计数减少8例(57.14%),C反应蛋白(CRP)、降钙素原(PCT)显著升高;5例(55.56%)脑脊液白细胞升高,葡萄糖降低,仅1例(11.11%)脑脊液培养为阳性。14例早产儿死亡7例,救治成功的7例早产儿采用美罗培南联合青霉素或万古霉素治疗。结论早产儿李斯特菌败血症发病时间早,临床症状不典型,病情进展快,并发症多,致死率致残率高,早期识别并及时给予有效抗生素治疗至关重要,危重患儿抗生素联合应用效果更好。

Objective To investigate the clinical characteristics of listeria monocytogenes(LM)septicemia in premature infants,and provide the reference for the clinical diagnosis and treatment of this disease.Methods A retrospective analysis of the clinical data of premature infants with LM admitted to the department of neonatology,Children′s Hospital of Soochow University from January 2011 to October 2020 was conducted.Results Among the 14 preterm infants,there were 9 boys and 5 girls.The median gestational age was 32.4 weeks(30.4-34.1 weeks),and the median birth weight was 1885 g(1513-2188 g).Prenatal fever,influenza-like symptoms and irregular abdominal pain were common maternal clinical symptoms.The onset seasons is mainly in spring and summer.Infected preterm infants experienced intrauterine distress in 12 cases(85.71%),asphyxia in 12 cases(85.71%),and amniotic fluid contamination in 11 cases(78.57%)during the perinatal period.And the symptoms were fever or hypothermia in 11 cases(78.57%),shortness of breath and moaning in 13 cases(92.86%),skin jaundice in 6 cases(57.14%),and skin rash in 8 cases(57.14%)after birth.The main complications were neonatal pneumonia,respiratory distress syndrome,septic shock,purulent meningitis,and intracranial hemorrhage.The laboratory examination showed:the white blood cells(WBC)count was significantly increased(>25×10;/L)in 7 cases(50%)and decreased(<5×109/L)in 2 cases,platelet count was significantly decreased in 8 cases(57.14%),and C-reactive protein(CRP)and procalcitonin(PCT)were significantly increased.5 cases(55.56%)increased in cerebrospinal fluid white blood cells and decreased glucose content,only 1 case(11.11%)was positive for cerebrospinal fluid culture.In total,7 of the 14 premature infants died,and the 7 preterm infants who were successfully treated were used meropenem combined with penicillin or vancomycin.Conclusion LM septicemia in premature infants has an early onset time,atypical clinical symptoms,rapid progress,many complications,and a high lethality and disability rate.Early identification and timely treatment of effective antibiotics are essential,and combined application of antibiotics in critical cases is considered effective.