29例新生儿恶臭假单胞菌感染临床特点分析

Clinical characteristics of 29 cases of neonatal pseudomonas putida infection

目的分析29例新生儿恶臭假单胞菌感染的临床特点,为临床诊治提供参考。方法选取2017年2月至2023年2月湖南省儿童医院新生儿科收治住院的恶臭假单胞菌感染新生儿29例。对其临床资料进行回顾性分析。结果29例新生儿平均胎龄为(33±4)周;足月儿9例,早产儿20例;平均出生体质量为(2187±1053)g,其中极低出生体重儿13例;有广谱抗菌药物用药史,感染前多有长时间静脉营养,12例有机械通气史,11例有消化道疾病手术史,11例经外周静脉穿刺中心静脉置管。临床表现以发热、呼吸困难、反应差、腹胀等为主,出现症状时间为日龄(22±6)d。5例(17.2%)患儿血白细胞计数低,11例(37.9%)血小板计数<100×10^(9)/L,26例(89.7%)C反应蛋白增高,浓度为(64.7±62.5)mg/L,降钙素原增高,浓度为(4.4±4.1)μg/L,白细胞介素-6明显升高9例,其中4例白细胞介素-6>5μg/L,血红蛋白为(101.0±22.8)g/L,球蛋白为(15.6±3.8)g/L,水平偏低。血培养、痰培养、脑脊液培养为鉴定方法,该菌对头孢吡肟、阿米卡星、左氧氟沙星敏感度较高,抗感染治疗后预后大多良好。27例(93.1%)治愈,2例(6.9%)死亡。结论新生儿感染恶臭假单胞菌多以血源性感染为主,早产儿、低出生体重儿、免疫功能低下者易感,有创操作提高感染该菌的风险,抗生素优先选择头孢菌素类、氨基糖苷类、喹诺酮类,选用敏感抗生素治疗预后较好。

Objective To analyze the clinical characteristics of neonatal pseudomonas putida infection in our hospital,and provide reference for clinical diagnosis and treatment.Methods The clinical data of 29 neonatal pseudomonas putida infection treated in the hospital from February 2017 to February 2023 were analyzed retrospectively.Results The average gestational age of 29 neonates was(33±4)weeks,including 9 full-term babies and 20 premature babies;the average birth weight was(2187±1053)g,including 13 very low birth weight infants.All patients were treated with broad-spectrum antibacterial drugs,and were mostly given long-term parenteral nutrition before infection.Twelve patients had mechanical ventilation,11 cases had a surgical history of gastrointestinal disease,and 11 cases had peripheral insertion of central catheters(PICC).The main clinical manifestations were fever,dyspnea,poor response and abdominal distension.Manifestations appeared(22±6)days after birth.Five cases(17.2%)infants were with low white blood cell(WBC)counts,11 cases(37.9%)had thrombocytopenia(<100×10^(9)/L),26 cases(89.7%)had elevated C-reactive protein(CRP),with the average CRP level being(64.7±62.5)mg/L;the average PCT level was increased,being(4.4±4.1)μg/L;interleukin-6(IL-6)was significantly increased in 9 cases,of which interleukin of 4 cases was>5μg/L;hemoglobin level was(101.0±22.8)g/L,and globulin level was(15.6±3.8)g/L,levels being low.Blood culture,sputum culture and bacterial culture of CSF were the identification methods,the bacteria were more sensitive to cefepime,amikacin and levofloxacin,and the prognosis was mostly good after anti-infection treatment.A total of 27 cases(93.1%)were cured and 2 cases(6.9%)died.Conclusion The neonates infected with pseudomonas putida are mainly blood-borne infections,and premature infants,low birth weight infants and immunocompromised infants are susceptible.Invasive operation increases the risk of infection with this bacteria,and cephalosporins,aminoglycosides and quinolones are preferred as antibiotics.Sensitive antibiotics should be selected for treatment,which has a better prognosis.