CAJ | 학술논문

目的了解极低和超低出生体重儿败血症临床特点、病原菌分布及药物敏感情况,以指导临床合理用药.方法对1999年1月1日至2008年12月31日温州医学院附属育英儿童医院新生儿重症监护病房收治的56例极低和超低出生体重儿败血症(早发型败血症3例,晚发型败血症53例)临床特点、血培养结果及药物敏感情况进行回顾性分析.结果极低和超低出生体重儿败血症临床表现无特征性.血培养结果阳性43例,以条件致病菌为主,其中新生儿早发型败血症血培养阳性1例.为脑膜炎败血黄杆菌;新生儿晚发型败血症血培养病原菌中,革兰阴性细菌主要是肺炎克雷伯菌(33.3%,14/42);革兰阳性细菌以凝固酶阴性葡萄球菌为首(26.2%,11/42),其次是肠球菌(11.9%,5/42);另有真菌感染2例,为白念珠菌败血症(4.8%,2/42).药物敏感试验方面,所有凝固酶阴性葡萄球菌均为耐苯唑西林凝同酶阴性葡萄球菌,对大部分β-内酰胺类抗生素耐药,对林可霉素、氨基糖苷类、大环内酯类及喹诺酮类抗生素亦不敏感,但对万古霉素未发现耐药,对利福平均敏感;所有肺炎克雷伯菌均产超广谱β-内酰胺酶,仅对碳青霉烯类、氨基糖苷类以及喹诺酮类等少数抗生素敏感.56例败血症患儿治愈43例,死亡13例(包括6例病情恶化放弃治疗),病死率为23.2%.结论极低和超低出生体重儿败血症临床表现缺乏特异性,病原菌主要为条件致病菌,并存在多重耐药,对可疑败血症患儿应及时行病原学检查及药物敏感试验,合理选择抗生素.为减少多重耐药菌感染的发生,应正确合理使用第三代头孢菌素.
목적 료해겁저화초저출생체중인패혈증림상특점、병원균분포급약물민감정황,이지도림상합리용약.방법 대1999년1월1일지2008년12월31일온주의학원부속육영인동의원신생인중증감호병방수치적56례겁저화초저출생체중인패혈증(조발형패혈증3례,만발형패혈증53례)림상특점、혈배양결과급약물민감정황진행회고성분석.결과 겁저화초저출생체중인패혈증림상표현무특정성.혈배양결과양성43례,이조건치병균위주,기중신생인조발형패혈증혈배양양성1례.위뇌막염패혈황간균;신생인만발형패혈증혈배양병원균중,혁란음성세균주요시폐염극뢰백균(33.3%,14/42);혁란양성세균이응고매음성포도구균위수(26.2%,11/42),기차시장구균(11.9%,5/42);령유진균감염2례,위백념주균패혈증(4.8%,2/42).약물민감시험방면,소유응고매음성포도구균균위내분서서림응동매음성포도구균,대대부분β-내선알류항생소내약,대림가매소、안기당감류、대배내지류급규낙동류항생소역불민감,단대만고매소미발현내약,대리복평균민감;소유폐염극뢰백균균산초엄보β-내선알매,부대탄청매희류、안기당감류이급규낙동류등소수항생소민감.56례패혈증환인치유43례,사망13례(포괄6례병정악화방기치료),병사솔위23.2%.결론겁저화초저출생체중인패혈증림상표현결핍특이성,병원균주요위조건치병균,병존재다중내약,대가의패혈증환인응급시행병원학검사급약물민감시험,합리선택항생소.위감소다중내약균감염적발생,응정학합리사용제삼대두포균소.
Objective To review the basic clinical characteristics and the pathogens and their antimicrobial susceptibilities to neonatal sepsis in very low birth weight infants (VLBWI) and extremely low birth weight infants ( ELBWI) for selection of appropriate antibiotics. Methods A retrospective chart review of 56 cases with neonatal sepsis(early onset neonatal sepsis 3 cases, late onset 53 cases) in VLBWI and ELBWI admitted to the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 1, 1999 to December 31, 2008 was conducted. The basic clinical characteristics and the results of blood culture and antimicrobial susceptibilities were analyzed. Results Among the 56 cases, the clinical presentations were non-specific. A total of 43 strains of bacteria were isolated, and the most important pathogens responsible for neonatal sepsis in VLBWI and ELBWI were opportunistic pathogenic bacteria. In early onset neonatal sepsis, there was only one culture-proven sepsis that was Chryseobacterium meningosepticum. In the late onset neonatal sepsis cases, the main pathogens of Gram-negative organisms were Klebsiella pneumoniae (33. 3%, 14/42), and the most common Gram-positive organisms were coagulase-negative Staphylococci (26. 2%, 11/42), followed by Enterococcus species (11. 9%,5/42). Furthermore, there were 2 fungal sepsis(4. 8%, 2/42), which were infected by Candida albicans. All of the coagulase-negative Staphylococci were methicillin-resistant coagulase-negative Staphylococci, and they were resistant to common antibiotics and sensitive to vancotnycin and rifampicin. And all of the Klebsiella pneumoniae produced extended-spectrum (Hactamases, which were sensitive only to a few antibiotics such as carbopenems, aminoglycosides and quinolones. Among those 56 cases, 43 patients were cured, 13 died, including six patients who refused any treatments, the mortality rate of neonatal sepsis in VLBWI and ELBWI was 23. 2%. Conclusions The clinical presentations of neonatal sepsis in VLBWI and ELBWI were non-specific, and the most important pathogens were opportunistic pathogenic bacteria, which were multi-drug resistant. Routine blood culture should be taken from infants who are suspected of neonatal sepsis and empirical use of appropriate antibiotics should be initiated as soon as the blood specimen for culture has been drawn. To reduce the occurrence of multi-drug resistant bacteria, we should restrict the use of antibiotics especially the third generation of cephalosporins in neonates as much as possible.