早产儿并低出生体重儿医院感染的临床特征及耐药现状分析

Analysis of clinical characteristics and drug resistance status of nosocomial infections in premature infants with low birth weight infants

目的分析早产儿并低出生体重儿医院感染的临床特征及常见感染部位致病菌株的耐药性,为临床早诊断、早治疗提供参考。方法回顾性分析2017年6月至2020年6月河南省省立医院新生儿重症监护病房收治的217例早产儿并低出生体重儿的病例资料。结果217例早产儿并低出生体重儿中男110例(50.69%)、女107例(49.31%),男女比为1.03∶1;感染患儿72例(33.18%)、未感染患儿145例(66.82%);近3年例次感染率为23.08%~48.65%,呈下降趋势。感染患儿与未感染患儿在胎龄、有无肠外营养方面构成差异有统计学意义(P<0.05),感染患儿降钙素原、白细胞介素-6在细菌学阳性与阴性间有差异。感染部位排名前两位的是肺部和消化道,常见致病菌株有表皮葡萄球菌、金黄色葡萄球菌和链球菌,其中表皮葡萄球菌、金黄色葡萄球菌对青霉素(78.57%、83.33%)、克林霉素(92.86%、91.67%)、红霉素(92.86%、91.67%)耐药率较高,链球菌对青霉素(66.67%)、庆大霉素(88.89%)仍保持一定的敏感性,甲氧西林耐药的金黄色葡萄球菌和甲氧西林耐药的表皮葡萄球菌检出率分别为66.67%和78.57%,未发现耐万古霉素的屎肠球菌。9株肺炎链球菌血清型鉴定,其中14型2株、19F型2株、19A型1株、6B型1株、23F型1株。13价肺炎球菌蛋白多糖结合疫苗的血清型覆盖率100%。结论早产儿并低出生体重儿胎龄越小、肠外营养时间越久,感染风险越大,目前感染病原菌的耐药现状存在地区和医院间的差异。

Objective To analyze the clinical features of nosocomial infections in premature infants with low birth weight infants and the drug resistance of pathogenic strains in common infection sites in order to provide a reference for early clinical diagnosis and early treatment.Methods A retrospective analysis was carried out in 217 cases of premature infants and low birth weight admitted to the neonatal intensive care unit of Henan Provincial Hospital from June 2017 to June 2020.Results Among the 217 cases of premature infants with low birth weight there were 110 males(50.69%)and 107 females(49.31%),the ratio of male to female being 1.03∶1.There were 72 cases of infected children(33.18%)and 145 cases of uninfected children(66.82%).In the past 3 years,the infection rate was 23.08%to 48.65%,showing a downward trend.There was a statistically significant difference in gestational age and parenteral nutrition between infected and uninfected children(P<0.05).There are differences in PCT and IL-6 in children with infections between positive and negative bacteriology.The top two infection sites were the lungs and digestive tract,Common pathogenic strains were Staphylococcus epidermidis,Staphylococcus aureus and Streptococcus;Staphylococcus epidermidis and Staphylococcus aureus were highly resistant to penicillin(78.57%,83.33%),clindamycin(92.86%,91.67%)and erythromycin(92.86%,91.67%);Streptococcus remained sensitive to penicillin(66.67%)and gentamicin(88.89%).The detection rates of MRSA and MRSCN were 66.67%and 78.57%.No vancomycin-resistant Enterococcus faecium was found.Serotype identification was made in 9 strains of Streptococcus pneumoniae,and there were 2 strains of Type 14,2 strains of 19F type,1 strain of 19A type,1 strain of 6B type,and 1 strain of 23F type.Serotype coverage of 13-valent pneumococcal proteoglycan conjugate vaccine was 100%.Conclusion Premature infants with low birth weight who have a lower gestational age and longer parenteral nutrition are at a higher risk of infection.The current status of drug resistance of infectious pathogens varies among regions and hospitals.