妊娠期李斯特菌感染20例临床分析

Clinical analysis and literature review of 20 cases of pregnancy listeriosis

目的:分析妊娠期李斯特菌感染患者的临床特征及母儿结局。方法:选择2017年1月至2021年12月在成都市妇女儿童中心医院产科分娩并诊断李斯特菌感染的孕妇共20例,回顾分析其症状、分娩情况、实验室检查、胎盘病理结果与治疗情况,以及新生儿产时情况、实验室指标、抗生素治疗情况及预后。结果:20例患者就诊的主要症状为腹痛、发热及胎动异常。起病孕周28^(+1)~39^(+5)周,分娩孕周28^(+1)~39^(+5)周。阴道分娩率35.0%(7/20),剖宫产率65.0%(13/20),70.0%(14/20)发现羊水粪染,15.0%(3/20)发现血性羊水。活产新生儿18例,44.4%(8/18)出现新生儿窒息。产妇均预后良好。18例活产新生儿均在1日内出现症状,17例诊断为李斯特菌败血症,1例诊断新生儿肺炎。6例新生儿因病情严重家长放弃治疗,余12例经治疗后好转,住院时间14~49d。结论:李斯特菌感染对孕妇及新生儿危害严重,其症状不典型,对于不明原因早产、发热及胎儿窘迫的孕妇应考虑到李斯特菌感染的可能,早期采用覆盖李斯特菌的抗生素治疗可改善母儿结局。

Objective:To analyze the clinical characteristics and outcomes of listeriosis in perinatal women and newborns.Methods:A total of 20 patients with listeriosis hospitalized in Obstetrics Department of Chengdu Women's and Children's Central Hospital from January 2017 to December 2021 were chosen.The symptoms,delivery condition,laboratory indexes,pathological results and treatment of perinatal women were analyzed.The delivery condition,laboratory indexes,antibiotic treatment and prognosis of newborns were analyzed.Results:The main symptoms of the perinatal women were abdominal pain,fever and abnormal fetal movement.The onset gestational weeks were 28^(+1) to 39^(+5) weeks and the delivery gestational weeks were 28^(+1) to 39^(+5) weeks.The rate of vaginal delivery was 35.0%(7/20)and the rate of cesarean section was 65.0%(13/20).Meconium stained amniotic fluid was found in 70.0%(14/20)patients and bloody amniotic fluid was found in 15.0%(3/20)patients.There were 18 live births of the 20 perinatal women.44.4%(8/18)were asphyxia.The prognosis of perinatal women was good.18 cases of neonatal patients had symptoms within 1 day.17 cases were diagnosed with Listeria septicemia while one case was diagnosed with neonatal pneumonia only.The parents of 6 newborns gave up treatment because of their serious condition.12 cases were cured after treatment.The length of stay was 14 to 49 days.Conclusion:Listeria is harmful to pregnant women and newborns.The symptoms may not be typical.For perinatal women with unexplained preterm birth,fever or fetal distress,the possibility of lsteria infection should be considered.Early antibiotic treatment covering listeria can improve the outcome of mothers and infants.