CAJ | 학술논문

目的：探讨革兰阳性菌及革兰阴性菌所致新生儿社区获得性败血症晚发型的临床特点及药敏情况。方法：收集我院2009年1月至2012年12月收治的83例致病菌为革兰阳性菌和革兰阴性菌的新生儿社区获得性败血症晚发型的临床资料，进行回顾性分析。结果：83例新生儿社区获得性败血症晚发型中革兰阳性菌53例，占63．9％，以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主；革兰阴性菌30例，占36．1％，以大肠埃希菌为主。检出的革兰阳性菌对红霉素、青霉素敏感率最低，对左氧氟沙星、庆大霉素、四环素部分敏感，万古霉素高度敏感。检出的革兰阴性菌对头孢噻吩、氨苄青霉素敏感率较低，对头孢他定、头孢曲松、环丙沙星、庆大霉素部分敏感，美罗培南高度敏感。革兰阳性菌感染多见于足月儿，革兰阴性菌感染多见于早产儿，对比两组围产情况无统计学差异，临床表现缺乏特异性。脐部感染多引起革兰阳性菌败血症。血小板降低多见于革兰阴性菌败血症，而在白细胞、杆状核细胞/中性柱细胞、CRP 上无差异。结论：新生儿社区获得性败血症晚发型临床表现无特异性，早期诊断需结合胎龄、感染部位、非特异性指标变化，抗生素应用应依据药敏结果。
목적：탐토혁란양성균급혁란음성균소치신생인사구획득성패혈증만발형적림상특점급약민정황。방법：수집아원2009년1월지2012년12월수치적83례치병균위혁란양성균화혁란음성균적신생인사구획득성패혈증만발형적림상자료，진행회고성분석。결과：83례신생인사구획득성패혈증만발형중혁란양성균53례，점63．9％，이응고매음성포도구균、금황색포도구균위주；혁란음성균30례，점36．1％，이대장애희균위주。검출적혁란양성균대홍매소、청매소민감솔최저，대좌양불사성、경대매소、사배소부분민감，만고매소고도민감。검출적혁란음성균대두포새분、안변청매소민감솔교저，대두포타정、두포곡송、배병사성、경대매소부분민감，미라배남고도민감。혁란양성균감염다견우족월인，혁란음성균감염다견우조산인，대비량조위산정황무통계학차이，림상표현결핍특이성。제부감염다인기혁란양성균패혈증。혈소판강저다견우혁란음성균패혈증，이재백세포、간상핵세포/중성주세포、CRP 상무차이。결론：신생인사구획득성패혈증만발형림상표현무특이성，조기진단수결합태령、감염부위、비특이성지표변화，항생소응용응의거약민결과。
Objective:To explore the clinical characteristics of late-onset neonatal community acquired sepsis caused by gram-positive and gram-negative bacteria and the drug susceptibility .Method: Collected the clinical data of 83 cases of late-onset neonatal community acquired sepsis , which were hospitalized be-tween January 2009 and December 2012 in our hospital , and were caused by gram-positive and gram-nega-tive bacteria.Result:There were 53 cases (63.9%)caused by gram positive bacteria in 83 cases, mainly the coagulase negative staphylococcus and staphylococcus aureus , another 30 cases ( 36.1%) were caused by gram negative bacteria , primary the e.coli.The gram positive bacteria had the lowest sensitivity to erythro-mycin , penicillin , and were partially sensitive to levofloxacin , gentamycin , and tetracycline , but were highly sensitive to vancomycin .The gram-negative bacteria detected had a lower sensitivity to cefalotin and ampicil-lin, and were partially sensitive to cephalosporin , ceftriaxone, ciprofloxacin and gentamycin , but were highly sensitive to meropenem .Gram-positive bacteria mostly infected full term infants , and gram-negative bacteria infection mainly happened in premature infants , there was no statistical difference in perinatal situation of the two groups, and were lack of specificity in clinical manifestations .Navel infection usually resulted in gram-positive bacteria septicemia .PLT decreased often in gram-negative bacteria sepsis , but there was no differ-ence in WBC , I/T and CRP .Conclusion:Late-onset neonatal community acquired sepsis are lack of speci-ficity in clinical manifestations , early diagnosis should be combined with the gestational age , the most com-monly infected site , and changes of the nonspecific index , application of antibiotics should be according to the results of drug susceptibility .