新生儿早发型败血症与晚发型败血症病原菌分布及炎性因子变化比较

Comparison of pathogen distribution and inflammatory factors in neonates with early-onset sepsis and late-onset sepsis

目的:探究新生儿早发型败血症(EOS)与晚发型败血症(LOS)病原菌分布及炎性因子变化。方法:选取2019年10月—2020年12月本科室收治的新生儿败血症患儿60例,其中30例EOS患儿作为早发组,30例LOS患儿作为晚发组。比浊法检测血超敏C反应蛋白(hs-CRP)水平,电化学发光法检测降钙素原(PCT)水平,血培养进行病原菌检测,MIC法进行药敏试验。结果:EOS患儿胎龄、出生体质量、出生窒息、母孕期感染、胎膜早破和宫内窘迫发生率要显著高于LOS(P<0.05)。早发组感染革兰阴性菌菌株数显著高于晚发组,而感染革兰阳性菌菌株数则显著低于晚发组(P<0.05);早发组病原菌主要以大肠埃希菌(26.67%)和肺炎克雷伯菌(16.67%)为主;晚发组病原菌主要以凝固酶阴性葡萄球菌(30.00%)和金黄色葡萄球菌(16.67%)为主;革兰阴性菌及革兰阳性菌对青霉素、氨苄西林耐药率均较高,对头孢曲松耐药率均较低。与晚发组相比,早发组血白细胞(WBC)、hs-CRP和PCT水平无显著性差异(P>0.05),血小板(PLT)水平显著降低(P<0.05)。治疗36 h后,两组PLT水平均显著增加,而血PCT、hs-CRP则显著降低(P<0.05),WBC水平仍无显著性差异(P>0.05)。结论:EOS与LOS的主要病原菌构成、耐药性以及炎性细胞因子水平有所不同,该结果对疾病的早期检测、区分疾病类型以及合理使用抗生素具有重要参考价值。

Objective:To explore the pathogen distribution and inflammatory factors in neonates with early-onset sepsis(EOS)and late-onset sepsis(LOS).Methods:From October 2019 to December 2020,60 cases of neonatal septicemia were selected,among them,30 cases with EOS were regarded as early onset group,and 30 cases with LOS children as late-onset group.The levels of hypersensitive C-reactive protein(hs-CRP)and procalcitonin(PCT)were measured by turbidimetry and electrochemiluminescence;blood culture was used to detect pathogenic bacteria and Mic method was used for drug sensitivity test.Results:The incidence of gestational age,birth weight,birth asphyxia,maternal pregnancy infection,premature rupture of membranes and intrauterine distress in EOS children were significantly higher than those in LOS children(P<0.05).The number of strains infected with Gram-negative bacteria in the early-onset group was significantly higher than that in the late-onset group,while the number of strains infected with Gram-positive bacteria in the early-onset group was significantly lower than that in the late-onset group(P<0.05);the main pathogens in early onset group were Escherichia coli(26.67%)and Klebsiella pneumoniae(16.67%);the main pathogens in late onset group were coagulase negative staphylococcus(30.00%)and Staphylococcus aureus(16.67%);the resistance rates of gram negative bacteria and gram positive bacteria to penicillin and ampicillin were higher,while that to ceftriaxone was lower.Compared with those in the late-onset group,the levels of white blood cell count(WBC),hs-CRP and PCT in the early-onset group had no significant difference(P>0.05),while the level of platelet(PLT)was significantly lower(P<0.05).After 36 hours of treatment,the level of PLT in both groups was significantly higher,while PCT and hs-CRP were significantly lower(P<0.05),and there was no significant difference in WBC level(P>0.05).Conclusion:The main pathogenic bacteria composition,drug resistance and inflammatory cytokine levels of EOS and LOS are different,which has important reference value for early detection of disease,differentiation of disease types and rational use of antibiotics.