极早产儿晚发型细菌感染败血症的危险因素及防治

Risk Factors and Prevention of Late-onset Bacterial Sepsis in Very Preterm Infants

【目的】分析极早产儿晚发型细菌感染败血症的临床特征及危险因素,提出可行的防治建议。【方法】选取2012年2月-2024年1月本院收治的94例晚发型细菌感染败血症的极早产儿作为研究对象,分析其围产期情况、临床症状、病原菌、危险因素及治疗等情况。【结果】极早产儿晚发型细菌感染败血症的发生率为8.40%(94/1119)。感染病原菌中以革兰阳性菌为主、占71.1%。Logistic回归分析提示:应用抗生素≥7 d、有创机械通气、留置中心静脉导管≥7 d及阴道分娩是极早产儿晚发型细菌感染败血症的主要危险因素,相对危险度(OR值)分别为2.787、4.243、3.033、2.174。【结论】极早产儿晚发型细菌感染败血症的病原菌以革兰阳性菌为主,长时间应用抗生素(≥7d)、有创机械通气、留置中心静脉导管(≥7d)及阴道分娩为极早产儿晚发型细菌感染败血症的高危因素。可通过采取加强围产期管理、缩短抗生素应用时间、减少有创操作的防治办法来降低极早产儿晚发型细菌感染败血症的发生率。

【Objective】To investigate the clinical features and high risk of very preterm infants with late-onset bacteri-al sepsis,so as to propose feasible prevention and treatment suggestions.【Methods】Totally 94 very preterm infants with late-onset bacterial sepsis from the Neonatology Department of Women’s Hospital of Jiangnan University were recruited from February,2012 to January,2024.Their clinical data,including the perinatal situation,clinical symptoms,patho-gens,risk factors and treatment,were collected and analyzed.【Results】The incidence rate of very preterm infants with late-onset bacterial sepsis were 8.40 for 100 live birth babies.The major pathogens of the infections among these very pre-mature infants included gram-positive bacteria(71.1%).Logistic regression analysis showed that long term(≥7 d)use of antibiotics,invasive mechanical ventilation,indwelling central venous catheter(≥7 d),and vaginal delivery were high risk factors of very preterm infants with late-onset bacterial sepsis,the relative risk(OR)values were 2.787,4.243,3.033 and 2.174,respectively.【Conclusion】The gram-positive bacteria are the main pathogens of late-onset bacterial sepsis in very preterm infants.Long term(≥7 d)use of antibiotics,invasive mechanical ventilation,indwelling central ve-nous catheter(≥7 d)and vaginal delivery are high risk factors of very preterm infants with late-onset bacterial sepsis.The incidence of late-onset bacterial sepsis in very preterm infants can be reduced by strengthening perinatal management,shortening the time of antibiotic application and reducing invasive operations.