不同新生儿败血症病原菌、耐药性及影响因素研究

Study on pathogenic bacteria, drug resistance and influencing factors of different neonatal septicemia

目的 探讨早发型与晚发型新生儿败血症病原菌、耐药性情况及分析其影响因素。方法 回顾性分析2018年5月至2020年5月于邯郸市中心医院诊治的214例败血症新生儿与538例无败血症新生儿的临床资料,其中败血症患儿根据发病时间分为早发型组(出生72h内,n=134)与晚发型组(出生72h后,n=80),观察新生儿败血症病原菌分布情况及主要病原菌的耐药性,并分析新生儿并发败血症的危险因素。结果 早发型败血症致病菌中革兰阳性菌与革兰阴性菌各67株(50.00%),以大肠埃希菌、表皮葡萄球菌、其他凝固酶阴性葡萄球菌(GNS)最为常见;晚发型败血症致病菌中革兰阳性菌共68株(85.00%),革兰阴性菌共12株(15.00%),以表皮葡萄球菌、其他GNS、金黄色葡萄球菌较为多见;药敏结果显示,表皮葡萄球菌对青霉素的耐药率最高,其次为氨苄西林;大肠埃希菌对阿莫西林/克拉霉素耐药性最高,其次为氨苄西林、头孢唑林;多因素Logistic回归分析显示,早发型败血症的危险因素为新生儿窒息、宫内窘迫、羊水污染、孕产妇发热、肺部感染(OR值介于24.753~187.485之间,P<0.05);晚发型败血症的危险因素为早产、低出生体重、脐部感染、有创操作(OR值介于7.772~52.949之间,P<0.05)。结论 新生儿窒息、宫内窘迫、羊水污染、孕产妇发热、肺部感染、早产、低出生体重、脐部感染、有创操作等是导致新生儿并发败血症的危险因素,临床应加以重视且根据其发病类型、病原菌及药敏结果选择合适的抗菌药物治疗。

Objective To explore the pathogenic bacteria and drug resistance of early-onset and late-onset neonatal sepsis, and analyze its influencing factors.Methods The clinical data of 214 neonates with sepsis and 538 neonates without sepsis who were diagnosed and treated in Handan Central Hospital from May 2018 to May 2020 were retrospectively analyzed.Among them, children with sepsis were divided into early-onset group(within 72 h of birth, n=134) and late-onset group(72 h after birth, n=80).The distribution of neonatal sepsis pathogenic bacteria and the drug resistance of the main pathogens were observed and the risk factors of neonatal sepsis were analyzed.Results There are 67 gram-positive bacteria(50.00%) and 67 gram-negative bacteria(50.00%) in the pathogenic bacteria of early-onset sepsis.Escherichia coli, Staphylococcus epidermidis, and other coagulase-negative staphylococci(GNS) are the most common.There were 68 gram-positive bacteria(85.00%) and 12 gram-negative bacteria(15.00%) among the pathogens of late-onset sepsis.Staphylococcus epidermidis, other GNS,and Staphylococcus aureus were more common.The drug sensitivity results showed that Staphylococcus epidermidis had the highest resistance rate to penicillin, followed by ampicillin.Escherichia coli had the highest resistance to amoxicillin/clarithromycin, followed by ampicillin and cefazolin.Multivariate logistic regression analysis showed that the risk factors for early-onset sepsis neonatal were asphyxia, intrauterine distress, meconium-stained amniotic fluid, maternal fever, and pulmonary infection(OR value ranged from 24.753 to 187.485,P<0.05),and risk factors for late-onset sepsis were premature birth and low birthweight, umbilical infection, invasive operation(OR value ranged from 7.772 to 52.949,P<0.05).Conclusion Neonatal asphyxia, intrauterine distress, meconium-stained amniotic fluid, maternal fever, pulmonary infection, premature birth, low birth weight, umbilical infection, invasive procedures and so on are risk factors leading to neonatal sepsis.Clinical attention should be paid and based on the type of disease, pathogenic bacteria and drug susceptibility results to choose appropriate antimicrobial treatment.