新生儿早发型与晚发型败血症临床特征

摘要

目的 分析新生儿败血症发生率、致病菌及药敏、血象特点、临床特征和病死率.方法 1999年1月至2008年12月出生并收入新生儿重症监护病房(NICU)的新生儿纳入研究.依据血培养阳性时间,将病例分为早发型( ≤生后7 d)和晚发型( ＞生后7 d)败血症.结果 66例新生儿共发生67次败血症,NICU新生儿败血症发生率为1.36%(66/4 860).早发型败血症新生儿多为足月儿,晚发型败血症多为极低体质量儿和早产儿(P ＜ 0.05).早发型败血症新生儿中主要致病菌为大肠埃希菌(33.3%)和B族链球菌(GBS)(31.0%),晚发型败血症新生儿主要致病菌为肺炎克雷伯菌(32.0%)和大肠埃希菌(28.0%).早发型败血症新生儿的病死率(21.4%)高于晚发型败血症新生儿(4.2%).结论 大肠埃希菌和GBS是造成早发型败血症的主要致病菌,肺炎克雷伯菌和大肠埃希菌是造成晚发型败血症的致病菌.产前对孕妇进行GBS筛查以及对所有GBS阳性孕妇产时预防性应用抗生素可能有助于预防新生儿早发型败血症.%Objective Neonatal sepsis is the most serious problem in neonatal intensive care unit, which results in significant mortality. The causative pathogens, drug sensitivity, hematological data, clinical course and mortality rate of neonatal sepsis were evaluated. Methods Neonates admitted to the neonatal intensive care unit (NICU) of lnternational Peaee Matenity and Children's Hospital between January 1999 and December 2008 were included in this study. They were divided into two groups according to the time of their positive culture test after birth, early-onset sepsis group (within the first 7 days of life) and late-onset sepsis groups (after 7 days). Results A total of 67 episodes of sepsis were identified in 66 neonates. The incidence of sepsis was 1.36％ among all NICU patients admitted at the same period. Most neonates with early-onset sepsis were term infants, while very low birth weight (VLBW) and preterm infants accounted for the majority of cases of late-onset sepsis (P ＜ 0.05). In early-onset sepsis, the most common pathogens responsible included Escherichia coli( E. coli) (33.3％) and group B streptococci (GBS) (31.0％). The most common causative mieroorganisms in late-onset sepsis were Klebsiella pneumoniae (32.0％) and E. coli (28.0％). The sepsis-related mortality rates were higher in early-onset sepsis (21.4％) than in late-onset sepsis (4.2％). Conclusions E. coli and GBS were found to he the leading pathogens in early-onset sepsis. The most common causative microorganisms of late-onset sepsis were Klebsiella pneumoniae and E. coli. GBS screening among pregnant women and intrapartum antibiotic prophylaxis performed to those GBS positive mothers were suggested to prevent their babies from early neonatal sepsis.