中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2008年
2期
124-127
,共4页
朱敏丽%郑戈%陈金妮%林振浪%朱将虎%林锦
硃敏麗%鄭戈%陳金妮%林振浪%硃將虎%林錦
주민려%정과%진금니%림진랑%주장호%림금
败血病%婴儿,新生%交叉感染%社区获得性感染%抗药性,细菌
敗血病%嬰兒,新生%交扠感染%社區穫得性感染%抗藥性,細菌
패혈병%영인,신생%교차감염%사구획득성감염%항약성,세균
Septicemia%Infant,newborn%Cross infection%Community-acquired infections%Drug resistance,bacteral
目的 晚发型败血症是新生儿期常见的感染性疾病,也是新生儿死亡的常见原因之一.新生儿一旦感染,病情可以迅速恶化,故早期有效的抗菌素治疗至关重要.该研究的目的 就是通过回顾性地分析晚发型新生儿败血症(LONS)的病原菌及其药敏,以指导临床早期对可疑LONS患儿合理用药.方法 对2002年1月1日至2005年12月31日温州医学院附属育英儿童医院NICU收住的具有临床表现以及至少一次血培养阳性的LONS临床特点、药敏进行回顾性分析.结果 102例LONS多通过皮肤、消化道、呼吸道等途径感染,临床表现无特异性.其中院内感染22例,社区感染80例,院内感染组与社区感染组比较,患儿胎龄小,体重轻,发病早(t=2.255、P＜0.01,t=8.818、P＜0.01,t=7.581、P＜0.05),差异有统计学意义.两组患儿血培养共检出110株病原菌,以凝固酶阴性葡萄球菌(CNS)居首(50/103,48.5%),其次为肺炎克雷伯杆菌(16/103,15.5%)、金黄色葡萄球菌(9/103,8.7%).社区感染主要病原菌为葡萄球菌属和大肠埃希菌,院内感染则为肺炎克雷伯菌.大部分(＞80%)的葡萄球菌尤其是CNS对青霉素类、红霉素及头孢唑啉耐药,MRSA达66.7%(6/9),但对万古霉素未发现耐药,大部分对利福平亦敏感.几乎所有(15/16)的ESBLS肺炎克雷伯菌具多重耐药性,仅对碳青霉烯类、氨基糖苷类以及喹诺酮类等少数抗菌药物敏感.发现1例对万古霉素耐药的粪肠球菌,然而,未发现B组链球菌感染的病例.结论 LONS临床表现非特异性,B组链球菌不是温州地区社区感染LONS的主要致病菌.由于医院和社区抗菌素的滥用,出现越来越多的多重耐药菌.对于可疑败血症患者应常规进行血培养以确定病原菌,并根据最可能的病原菌选用相关抗生素.为减少多重耐药菌感染的发生,应尽量减少第三代头孢菌素的使用.
目的 晚髮型敗血癥是新生兒期常見的感染性疾病,也是新生兒死亡的常見原因之一.新生兒一旦感染,病情可以迅速噁化,故早期有效的抗菌素治療至關重要.該研究的目的 就是通過迴顧性地分析晚髮型新生兒敗血癥(LONS)的病原菌及其藥敏,以指導臨床早期對可疑LONS患兒閤理用藥.方法 對2002年1月1日至2005年12月31日溫州醫學院附屬育英兒童醫院NICU收住的具有臨床錶現以及至少一次血培養暘性的LONS臨床特點、藥敏進行迴顧性分析.結果 102例LONS多通過皮膚、消化道、呼吸道等途徑感染,臨床錶現無特異性.其中院內感染22例,社區感染80例,院內感染組與社區感染組比較,患兒胎齡小,體重輕,髮病早(t=2.255、P＜0.01,t=8.818、P＜0.01,t=7.581、P＜0.05),差異有統計學意義.兩組患兒血培養共檢齣110株病原菌,以凝固酶陰性葡萄毬菌(CNS)居首(50/103,48.5%),其次為肺炎剋雷伯桿菌(16/103,15.5%)、金黃色葡萄毬菌(9/103,8.7%).社區感染主要病原菌為葡萄毬菌屬和大腸埃希菌,院內感染則為肺炎剋雷伯菌.大部分(＞80%)的葡萄毬菌尤其是CNS對青黴素類、紅黴素及頭孢唑啉耐藥,MRSA達66.7%(6/9),但對萬古黴素未髮現耐藥,大部分對利福平亦敏感.幾乎所有(15/16)的ESBLS肺炎剋雷伯菌具多重耐藥性,僅對碳青黴烯類、氨基糖苷類以及喹諾酮類等少數抗菌藥物敏感.髮現1例對萬古黴素耐藥的糞腸毬菌,然而,未髮現B組鏈毬菌感染的病例.結論 LONS臨床錶現非特異性,B組鏈毬菌不是溫州地區社區感染LONS的主要緻病菌.由于醫院和社區抗菌素的濫用,齣現越來越多的多重耐藥菌.對于可疑敗血癥患者應常規進行血培養以確定病原菌,併根據最可能的病原菌選用相關抗生素.為減少多重耐藥菌感染的髮生,應儘量減少第三代頭孢菌素的使用.
목적 만발형패혈증시신생인기상견적감염성질병,야시신생인사망적상견원인지일.신생인일단감염,병정가이신속악화,고조기유효적항균소치료지관중요.해연구적목적 취시통과회고성지분석만발형신생인패혈증(LONS)적병원균급기약민,이지도림상조기대가의LONS환인합리용약.방법 대2002년1월1일지2005년12월31일온주의학원부속육영인동의원NICU수주적구유림상표현이급지소일차혈배양양성적LONS림상특점、약민진행회고성분석.결과 102례LONS다통과피부、소화도、호흡도등도경감염,림상표현무특이성.기중원내감염22례,사구감염80례,원내감염조여사구감염조비교,환인태령소,체중경,발병조(t=2.255、P＜0.01,t=8.818、P＜0.01,t=7.581、P＜0.05),차이유통계학의의.량조환인혈배양공검출110주병원균,이응고매음성포도구균(CNS)거수(50/103,48.5%),기차위폐염극뢰백간균(16/103,15.5%)、금황색포도구균(9/103,8.7%).사구감염주요병원균위포도구균속화대장애희균,원내감염칙위폐염극뢰백균.대부분(＞80%)적포도구균우기시CNS대청매소류、홍매소급두포서람내약,MRSA체66.7%(6/9),단대만고매소미발현내약,대부분대리복평역민감.궤호소유(15/16)적ESBLS폐염극뢰백균구다중내약성,부대탄청매희류、안기당감류이급규낙동류등소수항균약물민감.발현1례대만고매소내약적분장구균,연이,미발현B조련구균감염적병례.결론 LONS림상표현비특이성,B조련구균불시온주지구사구감염LONS적주요치병균.유우의원화사구항균소적람용,출현월래월다적다중내약균.대우가의패혈증환자응상규진행혈배양이학정병원균,병근거최가능적병원균선용상관항생소.위감소다중내약균감염적발생,응진량감소제삼대두포균소적사용.
Objective Late onset neonatal septicemia(systemic infection after 72 hours of life)remains a major cause of neonatal morbidity and mortality.Early treatment with appropriate antibiotics is critical since infected infants Call deteriorate rapidly.The aim of this study was to review the pathogens responsible for late onset neonatal septicemia(LONS)and their antimicrobial susceptibilities in order to guide the initial selection of appropriate antibiotics for infants with suspected LONS.Methods A retrospective chart review of all cases with LONS seen in the neonatal intensive care unit (NICU)of Yuying Children's Hospital of Wenzhou Medical College from January 1,2002 to December 31,2005 was conducted.All cases were selected based on the clinical presentation and at least one positive result of blood culture.The basic clinical characteristics and the results of blood culture and antimicrobial susceptibilities were analyzed.Results A total of 102 cases with LONS were identified.Among those 102 cases,80 were community acquired(infants admitted from home and the blood culture was done on admission)and 22 were hospital acquired (infants became sick while in the NICU and the blood culture was done prior to use of antibiotics).The clinical presentations were non-specific.Compared to the infants with community acquired LONS,infants with hospital acquired LONS were usually born more prematurely(mean gestational age 33±3 vs 39±2 wks,t=2.255,P＜0.01),with lower weight(mean weight 1.79±0.70 vs 3.23±0.67 kg,t=8.818,P＜0.01)and with younger age(mean age 12±6 vs 16±7 days,t=7.581,P＜0.05).Of the 102 csses,a total of 103 strains of bacteria were isolated.Among the pathogenic bacteria isolated,the most common were eoagulase-negative Staphylococcus(CoNS)(50/103,48.5%),followed by Klebsiella pneumoniae(16/103,15.5%).The main pathogens for community acquired LONS were Staphylococcus species and Escherichia coli.The most important pathogen responsible for hospital acquired LONS was KlebsieUa pneumoniae.Most(＞80%)of the Staphylococcus especially CoNS were resistant to common antibiotics such as penicillin,erythromyein and cefazolin.Significant numbers(6/9)of Staphylococcus aureus isolated were methicillin-resistant Staphylococcus aureus(MRSA).However,all of the Staphyloccus isolates were sensitive to vancomycin.Almost all(15/16)of the Klebsiella pneumoniae isolated were multidrug resistant due to production of extended-spectrum β-lactamases(ESBLs).They were sensitive only to a few antibiotics such as carbopenems,aminoglycosides and quinolones.There was also one strain of vancomycin-resistant Enterococcus(VRE).Furthermore,there was no a single case of late onset neonatal sepsis due to infection with group B Streptococcus(GBS).Conclusions The clinical manifestations of late onset neonatal sepsis are usually non-specific.GBS is not a significant pathogen responsible for community
acquired LONS in the Wenzhou area.There are increasing numbers of multi-drug resistant bacterial species isolated from the newborn infants with late onset neonatal septicemia,which is most likely due the nonrestricted use of antibiotics in the hospitals as well as in the communities.A routine blood culture should be taken from any newborn infant who is suspected of LONS 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 multidrug resistant bacteria, the use of antibiotics especially the third generation cephalosporins in neonates should be restricted as much as possible.
