新生儿外科感染性疾病的治疗

摘要

Objective To study the feature of neonatal infections and characteristics of antibiotic treatment in a tertiary children ' s hospital. Methods Clinical data including incidence of infection, primary disease,species of bacteria, complication and antibiotic utilization in hospitalized patients from Jan. 2010 to Dec. 2012 were retrospectively reviewed using their medical records. Results Among 1826 patients admitted to neonetal surgery ward, 542 infants ( 29. 7％) were with infection. The incidence of antibiotic resistance was 23. 51％. The top five infectious diseases were:perianal abscess, necrotizing enterocolitis, colicitis, omphalitis and subcutaneous gangrene. 12 cases of multi-resistant infection were cured by non-restricted antibiotics. 109 were cured by restricted antibiotics. And other 7 were cured by special antibiotics. No death nor multi-resistant nosocomial infection were found. Risk factors including multi-site infection, premature or low birth weight infants, liver, kidney or heart dysfunction,fever lasting more than 3 days after antibiotic therapy, septic shock, sepsis, digestive tract perforation and peritonitis,were vital in choosing specific antibiotics. Conclusions Infection is one of the most common diseases in neonatal surgery ward, with major pathogens sensitive to antibiotics. The clinical characteristics and drug sensitive test are conductive to the reasonable use of antibiotics. Special antibiotics can be used directly in patients with risk factors Clinical doses of antibiotics in neonates depend on the monitoring of drug concentration.%目的 探讨新生儿外科感染性疾病的特点及抗菌药物治疗原则.方法 采用回顾性研究的方法对本院新生儿外科2010—2012年住院感染性病例的构成比、病种、致病菌、并发症、抗生素使用情况等进行分析.结果 研究期间新生儿外科共收治患儿1 826例,其中感染性疾病542例,占同期住院新生儿的29.7％,耐药菌感染率23.6％.前五位感染性疾病为肛周脓肿、坏死性小肠结肠炎、脐炎、结肠炎、皮下坏疽.128 例多重耐药菌感染病例中,使用非限制级抗生素12例,限制级抗生素109例,特殊级抗生素7例.未发现死亡病例或多重耐药菌医院感染病例.多发性感染灶、早产和(或)低出生体重、肝肾功能和(或)心肌标志物异常、使用抗生素后发热超过3天、感染性休克、败血症和(或)脓毒血症、消化道穿孔和(或)全腹膜炎等高危因素对使用特殊级抗生素有重要参考价值.结论 感染性疾病是新生儿外科最常见疾病之一,病原体以敏感菌为主;抗生素选用需根据疾病特点及药敏试验结果而定,对于有高危因素的新生儿感染病例可直接使用特殊级抗生素;新生儿的抗生素剂量需根据血药浓度监测调整.