新生儿晚发型B族链球菌败血症临床特征及预后分析

摘要

目的探讨晚发型B族链球菌（GBS）败血症的临床特征及预后情况。方法回顾性分析新生儿重症监护室（NICU）2007年1月-2011年12月出院诊断晚发型GBS败血症的15例新生儿以及同期出院诊断为晚发型非GBS革兰阳性菌败血症34例新生儿的临床资料。结果晚发型GBS败血症与晚发型非GBS革兰阳性菌败血症新生儿在气促、抽搐和呼吸暂停等临床表现方面，差异有统计学意义（P均<0.05）。晚发型GBS败血症组脑脊液白细胞计数>100×106/L、超敏C反应蛋白>100 mg/L及脑脊液葡萄糖<3.11 mmol/L的比例高于非GBS革兰阳性菌败血症组（P<0.05）。GBS对青霉素、氨苄青霉素、头孢曲松、哌拉西林/他唑巴坦、左氧氟沙星、万古霉素敏感，对红霉素及庆大霉素耐药率均为87.5%。晚发型GBS败血症与非GBS革兰阳性菌败血症患儿在并发脑膜炎及脑积水、脑室管炎等后遗症的差异也有统计学意义（P<0.05），但病死率的差异无统计学意义（P>0.05）。结论晚发型GBS败血症起病较隐匿，症状不典型，并发症多，且易有后遗症；对可疑GBS败血症新生儿应早期使用有效抗生素治疗。%Objectives To investigate the clinical characteristics and prognosis of late-onset group B streptococcal (GBS) sepsis. Methods From Jan. 2007 to Dec. 2011, iffteen neonates diagnosed with late onset GBS sepsis at discharge from NICU were retrospectively analyzed, meanwhile, thirty-four neonates diagnosed with late onset non-GBS Gram-positive bacteria sepsis at discharge were selected as controls during the same period. Results There were signiifcant differences in occurrence rates of shortness of breath, convulsion and apnea between late onset non-GBS sepsis group and late onset GBS sepsis group (P<0.05). The percentages of neonates with white blood cell count (CSF)>100×106/L, high-sensitivity C-reaction protein (hsCRP)>100 mg/L and glucose in CSF<3.11 mmol/L in late onset GBS sepsis group were higher than those in late onset non-GBS sepsis group (P<0.05). GBS was sensitive to penicillin, ampicillin, ceftriaxone, piperacillin/tazobactam, levolfoxacin and vancomycin. The rates of GBS resistance to erythromycin and gentamycin were both 87.5%. There were signiifcant differences in occurrence rates of meningitis, hydrocephalus and ependymitis between late onset GBS sepsis group and late onset non-GBS sepsis group (P<0.05), while no difference in mortality was found between two groups (P>0.05). Conclusions The late onset GBS sepsis is in-sidious, atypical, with many complications and sequelae. It is important for the suspicious neonates to use effective antibiotics as early as possible.