临床儿科杂志
臨床兒科雜誌
림상인과잡지
2014年
4期
330-335
,共6页
抗生素%胎儿%早发性败血症%晚发性败血症
抗生素%胎兒%早髮性敗血癥%晚髮性敗血癥
항생소%태인%조발성패혈증%만발성패혈증
antibiotics%fetal%early-onset sepsis%late-onset sepsis
目的：探讨母亲分娩前使用抗生素与早产儿早发型败血症（EOS）及晚发型败血症（LOS）发生以及病原菌的关系。方法选取2010年1月至2012年12月间胎龄≤33周，生后24h内住院，住院时间≥24 h的单胎早产儿；将母亲分娩前使用抗生素时间≥4 h作为抗生素组，未使用或使用抗生素时间<4 h为对照组，分析比较两组早产儿EOS和LOS的比例和致病菌情况。结果共入选629例早产儿，其中抗生素组232例，对照组397例。抗生素组早产儿的出生体质量、临床羊膜炎、产前激素>24h、EOS的发生比例均高于对照组，窒息和呼吸窘迫综合征（RDS）的发生比例均低于对照组，差异均有统计学意义（P<0.05）；两组LOS发生比例差异无统计学意义（P>0.05）。EOS 29例，5例（17.2%）合并化脓性脑膜炎，抗生素组EOS 16例，血培养阳性11例（68.8%），革兰阳性（G+）菌6例（37.5%），G-菌5例（31.3%）；对照组EOS 13例，血培养阳性5例（38.5%），G-菌4例（30.8%），G+杆菌1例（7.7%）；均以非耐药菌为主，两组EOS早产儿血培养阳性率和G+菌比例差异均无统计学意义（P>0.05）。LOS 75例，5例（6.7%）合并化脓性脑膜炎，与EOS差异无统计学意义（P>0.05）。抗生素组LOS 29例，血培养阳性17例（58.6%），G+菌6例（20.7%），G-菌9例（31.0%），真菌2例（6.9%）；对照组LOS 46例，血培养阳性23例（50.0%），G+菌14例（30.4%），G-菌8例（17.4%），真菌1例（2.2%）；均以耐药菌为主，两组LOS早产儿血培养阳性率以及G+菌比例差异均无统计学意义（P>0.05）。结论母亲分娩前使用抗生素，既没有减少早产儿EOS和LOS的发生概率，也未改变病原菌的分布。
目的：探討母親分娩前使用抗生素與早產兒早髮型敗血癥（EOS）及晚髮型敗血癥（LOS）髮生以及病原菌的關繫。方法選取2010年1月至2012年12月間胎齡≤33週，生後24h內住院，住院時間≥24 h的單胎早產兒；將母親分娩前使用抗生素時間≥4 h作為抗生素組，未使用或使用抗生素時間<4 h為對照組，分析比較兩組早產兒EOS和LOS的比例和緻病菌情況。結果共入選629例早產兒，其中抗生素組232例，對照組397例。抗生素組早產兒的齣生體質量、臨床羊膜炎、產前激素>24h、EOS的髮生比例均高于對照組，窒息和呼吸窘迫綜閤徵（RDS）的髮生比例均低于對照組，差異均有統計學意義（P<0.05）；兩組LOS髮生比例差異無統計學意義（P>0.05）。EOS 29例，5例（17.2%）閤併化膿性腦膜炎，抗生素組EOS 16例，血培養暘性11例（68.8%），革蘭暘性（G+）菌6例（37.5%），G-菌5例（31.3%）；對照組EOS 13例，血培養暘性5例（38.5%），G-菌4例（30.8%），G+桿菌1例（7.7%）；均以非耐藥菌為主，兩組EOS早產兒血培養暘性率和G+菌比例差異均無統計學意義（P>0.05）。LOS 75例，5例（6.7%）閤併化膿性腦膜炎，與EOS差異無統計學意義（P>0.05）。抗生素組LOS 29例，血培養暘性17例（58.6%），G+菌6例（20.7%），G-菌9例（31.0%），真菌2例（6.9%）；對照組LOS 46例，血培養暘性23例（50.0%），G+菌14例（30.4%），G-菌8例（17.4%），真菌1例（2.2%）；均以耐藥菌為主，兩組LOS早產兒血培養暘性率以及G+菌比例差異均無統計學意義（P>0.05）。結論母親分娩前使用抗生素，既沒有減少早產兒EOS和LOS的髮生概率，也未改變病原菌的分佈。
목적：탐토모친분면전사용항생소여조산인조발형패혈증（EOS）급만발형패혈증（LOS）발생이급병원균적관계。방법선취2010년1월지2012년12월간태령≤33주，생후24h내주원，주원시간≥24 h적단태조산인；장모친분면전사용항생소시간≥4 h작위항생소조，미사용혹사용항생소시간<4 h위대조조，분석비교량조조산인EOS화LOS적비례화치병균정황。결과공입선629례조산인，기중항생소조232례，대조조397례。항생소조조산인적출생체질량、림상양막염、산전격소>24h、EOS적발생비례균고우대조조，질식화호흡군박종합정（RDS）적발생비례균저우대조조，차이균유통계학의의（P<0.05）；량조LOS발생비례차이무통계학의의（P>0.05）。EOS 29례，5례（17.2%）합병화농성뇌막염，항생소조EOS 16례，혈배양양성11례（68.8%），혁란양성（G+）균6례（37.5%），G-균5례（31.3%）；대조조EOS 13례，혈배양양성5례（38.5%），G-균4례（30.8%），G+간균1례（7.7%）；균이비내약균위주，량조EOS조산인혈배양양성솔화G+균비례차이균무통계학의의（P>0.05）。LOS 75례，5례（6.7%）합병화농성뇌막염，여EOS차이무통계학의의（P>0.05）。항생소조LOS 29례，혈배양양성17례（58.6%），G+균6례（20.7%），G-균9례（31.0%），진균2례（6.9%）；대조조LOS 46례，혈배양양성23례（50.0%），G+균14례（30.4%），G-균8례（17.4%），진균1례（2.2%）；균이내약균위주，량조LOS조산인혈배양양성솔이급G+균비례차이균무통계학의의（P>0.05）。결론모친분면전사용항생소，기몰유감소조산인EOS화LOS적발생개솔，야미개변병원균적분포。
Objective To investigate the incidence and pathogen distribution of early-onset sepsis (EOS) and later-onset sepsis (LOS) in preterm infants exposed to antenatal antibiotics. Methods The singleton preterm infants with gestational age≤33 weeks who were admitted to our hospital within 24 hours after birth and had stayed for more than 24 hours were selected from Jan. 2010 to Dec. 2012. According to the exposure time of antenatal antibiotics, infants were divided into antibiotics group (≥4 hours) and control group (<4 hours). The proportion of EOS and LOS and pathogen distribution were compared between two groups. Results A total of 629 preterm infants, 232 in antibiotics group and 397 in control group, were selected. Compared with control group, the birth weight, percentages of clinical chorioamnionitis, prenatal hormone exposure>24 h and EOS were significantly higher while percentages of asphyxia and respiratory distress syndrome (RDS) were significantly lower in antibio-tics group (P<0.05). There was no difference in the occurrence of LOS between two groups (P>0.05). In 29 cases of EOS, 5 cases (17.2%) were complicated by suppurative meningitis. There were 16 cases of EOS in antibiotics group. Positive blood cul-ture was found in 11 cases (68.8%) including 6 Gram-positive (G+) and 5 Gram-negative (G-) bacteria. There were 13 cases of EOS in control group. Positive blood culture was found in 5 cases (38.5%) including 4 Gram-negative (G-) and 1 Gram-positive (G+) bacteria. Non-resistant bacteria were dominant in two groups and there was no difference in positive rate of blood culture and proportion of G+bacteria between two groups (P>0.05). In 75 cases of LOS, 5 cases (6.7%) were complicated by suppura-tive meningitis. There was no difference in incidence of meningitis between EOS and LOS cases (P>0.05). There were 29 cases of LOS in antibiotics group. Positive blood culture was found in 17 cases (58.6%) including 6 Gram-positive (G+) and 9 Gram-negative (G-) bacteria and 2 fungi. There were 46 cases of LOS in control group. Positive blood culture was found in 23 cases (50.0%) including 14 Gram-positive (G+) and 8 Gram-negative (G-) bacteria and 1 fungus. Drug-resistant bacteria were domi-nant in two groups and there was no difference in positive rate of blood culture and proportion of G+ bacteria between two groups (P>0.05). Conclusions Antenatal antibiotics exposure was not effective to either reduce the occurrence of EOS and LOS or change the distribution of pathogens in EOS and LOS in preterm infants.
