新生儿感染产单核细胞李斯特菌的临床特征分析

Infection Analysis of Listeria Monocytogenes in Newborns

目的分析新生儿感染产单核细胞李斯特菌(LM)的临床特征,增加国内新生儿感染LM的相关数据,以利于临床诊疗。方法回顾性分析该院在2016年6月至2023年5月感染LM新生儿的临床资料,包括患儿的性别、胎龄、体质量、Apgar评分等基本临床资料,患儿和患儿母亲的临床症状、实验室指标和抗菌药物使用情况,统计分析其相关临床特征及危险因素。结果研究共纳入23例感染LM的新生儿,其中4例为咽部感染,19例为无菌部位(血+脑脊液)感染。其中82.61%(19/23)的患儿有白细胞计数升高,91.30%(21/23)的患儿有C反应蛋白升高,30.43%(7/23)的患儿有降钙素原增高。患儿首发症状为呼吸急促(5例),呼吸困难(9例),无自主呼吸(6例),其他情况包括发热(7例),脑膜炎(12例),电解质紊乱(15例)等。在新生儿母亲中,13.04%(3/23)有生冷食物进食史,52.17%(12/23)存在发热(37.3~39.7℃),13.04%(3/23)腹泻,17.39%(4/23)腹痛,60.87%(14/23)存在产前感染的情况。新生儿病死率为21.74%(5/23),不良结局发生率为56.52%(13/23)。通过综合分析,比较存活患儿组和不良结局患儿组(死亡+放弃)的相关特征,结果显示仅Apgar评分(P=0.009)为预后的危险因素。结论临床需高度警惕孕妇感染症状和饮食史,一旦怀疑应立即进行细菌检测和预防性用药,并使用足够疗程的抗菌药物,避免不良结局的发生。

Objective To analyze the characteristics of Listeria monocytogenes in Neonatal infection,so as to expand the data of LM in Neonatal infection in China for clinical reference.Methods The clinical data of newborns infected with Listeria monocytogenes from June 2016 to May 2023 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed,Including basic clinical data such as the child′s gender,gestational age,weight,Apgar score,etc.There are also clinical symptoms,laboratory indicators,and antibiotic use of the patient and their mother,and their related clinical characteristics and risk factors were statistically analyzed.Results A total of 23 neonates infected with Listeria monocytogenes were included in the study,of which 4 cases were pharyngeal infection,19 cases were sterile site(blood+cerebrospinal fluid)infection,of which 82.61%(19/23)had WBC elevation,91.30%(21/23)had CRP elevation,and 30.43%(7/23)had PCT elevation.The first symptoms of the children were Tachypnea(5 cases),dyspnea(9 cases),and involuntary breathing(6 cases).Other conditions included fever(7 cases),meningitis(12 cases),and electrolyte disorders(15 cases).Among newborn mothers,13.04%(3/23)had a history of eating raw and cold foods,52.17%(12/23)had fever(37.3-39.7℃),13.04%(3/23)had diarrhea,17.39%(4/23)had abdominal pain and 60.87%(14/23)had prenatal infections.The neonatal mortality rate was 21.74%(5/19),and the adverse outcome rate was 56.52%(13/23).Through comprehensive analysis,the relevant characteristics of the surviving group and the adverse outcome group(death+abandonment)were compared,indicating that Apgar score(P=0.009)were risk factors for prognosis.Conclusion In clinical practice,it is necessary to be highly vigilant about the symptoms of infection and dietary history of pregnant women.Once suspected,bacterial testing and preventive medication should be carried out immediately,and sufficient courses of antibiotics should be used to avoid adverse outcomes.