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目的探讨早产儿晚发型败血症的危险因素及病原学特点。方法选择2012年1~12月入住我院新生儿科确诊或临床诊断晚发型败血症的早产儿为观察组,同期入住未并发败血症的早产儿为对照组。回顾性分析比较两组患儿的临床资料,以及血培养检出的病原菌分布情况和药敏情况。结果观察组60例,对照组290例。单因素分析显示出生胎龄≤32周、体重<1500 g、小于胎龄儿(SGA)、胎膜早破、胃管留置时间>14天、经外周中心静脉置管(PICC)、胃肠外营养时间>14天、并发坏死性小肠结肠炎(NEC)、并发巨细胞病毒(CMV)感染、新生儿重症监护室(NICU)住院时间>5天与早产儿晚发型败血症的发生有关(P<0.05)。Logistic回归分析显示,出生胎龄≤32周(OR=2.710,95%CI:1.200~6.121)、SGA(OR=4.114,95%CI:1.635~10.354)、PICC置管(OR=2.485,95%CI:1.178~5.239)、并发NEC(OR=15.270,95%CI:5.058~46.100)、CMV感染(OR=20.130,95%CI:5.279~76.754)为早产儿晚发型败血症的独立危险因素。观察组中20例血培养阳性,培养出革兰阴性菌13株(65%),其中肺炎克雷伯菌10株(50%)、大肠埃希菌2株(10%)、产酸克雷伯菌1株(5%);革兰阳性菌2株(10%),均为表皮葡萄球菌;真菌5株(25%),其中近平滑假丝酵母菌4株(20%),白色念珠菌1株(5%)。13株革兰阴性菌有10株为产超广谱β内酰胺酶(ESBLS)菌株,其中8株为肺炎克雷伯菌。结论出生胎龄≤32周、SGA、PICC置管、并发NEC、CMV感染为早产儿晚发型败血症的危险因素,肺炎克雷伯菌是最主要的致病菌,耐药性强,其次是近平滑假丝酵母菌。
Objective To explore the risk factors and etiological characteristics of late-onset sepsis in preterm infants. Methods From January to December 2012 admitted to our hospital neonatal diagnosis or clinical diagnosis of late-onset sepsis in preterm children as the observation group, admitted to the same period without premature sepsis in the control group. The clinical data of two groups of children were retrospectively analyzed and compared. The distribution of pathogenic bacteria and drug susceptibility detected by blood culture were also analyzed. Results The observation group of 60 cases, control group of 290 cases. Univariate analysis showed that gestational age ≤32 weeks, body weight <1500 g, less than gestational age (SGA), premature rupture of membranes, gastric tube indwelling time> 14 days, by peripheral central venous catheterization (PICC), parenteral Nutritional time> 14 days was associated with necrotizing enterocolitis (NEC), cytomegalovirus (CMV) infection, hospitalization for neonatal intensive care unit (NICU)> 5 days and late onset of late onset sepsis (P < 0.05). Logistic regression analysis showed that gestational age ≤ 32 weeks (OR = 2.710, 95% CI: 1.200 ~ 6.121), SGA (OR = 4.114, 95% CI: 1.635-10.354) (OR = 15.270, 95% CI: 5.058 ~ 46.100). CMV infection (OR = 20.130, 95% CI: 5.279 ~ 76.754) was an independent risk factor for late-onset septicemia in preterm infants. In the observation group, 20 blood cultures were positive, and 13 strains (65%) of gram-negative bacteria were cultured, among which 10 strains were Klebsiella pneumoniae (50%), 2 strains were Escherichia coli (10% 1 strain of Escherichia coli (5%), 2 strains of Gram-positive bacteria (10%), all of which were Staphylococcus epidermidis; 5 of which were fungi (25%), 4 of which were Candida parapsilosis (20% 1 strain (5%). Ten strains of 13 Gram-negative bacteria were ESBLs producing strains, of which 8 strains were Klebsiella pneumoniae. Conclusion Neonatal gestational age ≤32 weeks, SGA, PICC catheterization, complicated with NEC and CMV infection are risk factors for late-onset septicemia in neonates. Klebsiella pneumoniae is the most important pathogenic bacteria with strong drug resistance, followed by near Smooth Candida.