新生儿早发型和晚发型大肠埃希菌败血症临床指标及抗菌药物敏感性比较

Comparison of Clinical Indicators and Antimicrobial Susceptibility between Early-Onset and Late-Onset Escherichia Coli Sepsis in Neonates

目的:探讨新生儿早发型和晚发型大肠埃希菌败血症的临床差异。方法:选取我院2012年8月至2021年7月收治的大肠埃希菌败血症新生儿35例,依据发病时间分为早发组(生后≤3 d)19例和晚发组(生后>3 d)16例,比较两组患儿的临床指标和抗菌药物敏感性。结果:两组患儿羊水粪染、黄疸、呼吸暂停、硬肿症、感染性休克、坏死性小肠结肠炎、弥散性血管内凝血及细菌性脑膜炎发生率比较差异均无统计学意义(P均>0.05)。早发组母体感染、胎膜早破、生后窒息、凝血功能异常发生率均高于晚发组(P均<0.05),而体温异常、呕吐腹胀、低血糖症、呼吸衰竭发生率均低于晚发组(P均<0.05)。大肠埃希菌对哌拉西林/他唑巴坦、阿米卡星、亚胺培南及美罗培南的敏感率较高,两组患儿对临床常用抗菌药物的敏感率比较差异无统计学意义(P>0.05)。结论:新生儿早发型和晚发型大肠埃希菌败血症的临床表现有所不同,但对临床常用抗菌药物的敏感率比较差异无统计学意义;临床检测大肠埃希菌对抗菌药物的敏感性,有利于制定治疗方案,减少滥用抗菌药物。

Objective:To explore the clinical differences between early-onset and late-onset Escherichia coli sepsis in neonates.Methods:A total of 35 neonates with E.coli sepsis admitted into our hospital from Aug.2012 to Jul.2021 were enrolled.According to onset time,all patients were divided into 19 cases in the early-onset group(≤3 d after birth)and 16 cases in the late-onset group(>3 d after birth).Clinical indicators and antimicrobial susceptibility of two groups were compared.Results:There were no significant differences in the incidences of meconium-stained amniotic fluid,jaundice,apnea,scleredema,septic shock,necrotizing enterocolitis,disseminated intravascular coagulation and bacterial meningitis between two groups(P>0.05).The incidences of maternal infection,premature rupture of membranes,postnatal asphyxia and abnormal coagulation function in the early-onset group were higher than those in the late-onset group(P<0.05),while the incidences of abnormal body temperature,vomiting and abdominal distension,hypoglycemia and respiratory failure were lower than those in the late-onset group(P<0.05).The sensitivity rate of E.coli to piperacillin/tazobactam,amikacin,imipenem and meropenem was higher.There was no significant difference in the sensitivity rate of commonly used clinical antibiotics between two groups(P>0.05).Conclusion:The clinical manifestations of early-onset and late-onset E.coli sepsis in neonates are different,yet there is no significant difference in the susceptibility rate to commonly used antibiotics.Clinical detection of the susceptibility of E.coli to antibiotics is helpful for formulating the treatment regimens and reducing the abuse of antibiotics.