171例新生儿败血症临床特点及病原菌分析

发布时间：2018-02-25 03:23

本文关键词： 新生儿败血症临床特点细菌培养药敏实验　出处：《重庆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：总结新生儿败血症的临床特点、细菌培养阳性率、常见病原菌及其耐药情况，比较早、晚发新生儿败血症高危因素、局部感染发生率、合并症及各种病原菌感染率。方法：回顾性分析2010年9月至2011年8月我科收治的171例新生儿败血症的临床资料，统计分析新生儿败血症的常见高危因素、临床表现、局部感染发生率、合并症及病原学特点；按发病年龄将其分为早、晚发新生儿败血症两组，对高危因素、局部感染发生率、病原菌感染率进行比较分析。结果：早产、低出生体重、母羊水发臭或粪染、宫内窘迫、生后窒息、气管插管为早发新生儿败血症高危因素。新生儿败血症临床表现常不典型，以活动减少或嗜睡（63.4%）、皮肤黄疸（57.3%）、少吃（41.5%）、发热（39.8%）所占比例较高。最常见伴随局部感染为呼吸道感染（91.2%），其次为皮肤粘膜感染（28.1%），比较早、晚发新生儿败血症两组的皮肤黏膜感染率有显著统计学差异（P＜0.05）。该组病例99.4%合并有其他疾病，其中新生儿病理性黄疸（49.1%）最为常见。171例新生儿败血症患儿，细菌培养阳性率为49.1%，革兰阳性菌占74.1%，其中CONS占总菌株的55.3%，MRS占49.4%；革兰阴性菌占23.5%，其中产ESBLs革兰阴性菌共占总菌株的11.8%；真菌占2.4%。早、晚发两组新生儿败血症革兰阳性菌的感染率有显著统计学差异（P＜0.05）。青霉素类、红霉素、头孢西丁、苯唑西林、复方新诺明等对葡萄球菌的敏感度较低，，万古霉素对革兰阳性球菌完全敏感；青霉素类、一代头孢、氨曲南等对革兰阴性均敏感度较低，三代头孢对革兰阴性菌的敏感度有降低趋势；阿米卡星对于革兰阳性菌和革兰阴性菌包括产ESBLs均有较好的敏感性。结论：早产、低出生体重、母羊水发臭或粪染、宫内窘迫、生后窒息、气管插管为早发新生儿败血症高危因素。新生儿败血症往往伴随局部感染及各种合并症。早发及晚发新生儿败血症伴随局部感染的部位有显著统计学差异。我院新生儿科细菌培养阳性率较高，致病菌以革兰阳性菌为主，尤其CONS等条件致病菌仍是新生儿败血症主要致病菌。青霉素类、红霉素、一代头孢、头孢西丁、苯唑西林、氨曲南、复方新诺明等耐药率较高，已不适合作为新生儿败血症首选药物。
[Abstract]:Objective: to summarize the clinical characteristics of neonatal septicemia, the positive rate of bacterial culture, the common pathogens and their drug resistance, the high risk factors of early and late neonatal septicemia, the incidence of local infection, the complication and the infection rate of various pathogens. Methods: the clinical data of 171 cases of neonatal septicemia from September 2010 to August 2011 were analyzed retrospectively. The common high risk factors, clinical manifestations and local infection rate of neonatal septicemia were statistically analyzed. According to the age of onset, the patients were divided into two groups: early and late neonatal septicemia. The high risk factors, the incidence of local infection and the infection rate of pathogenic bacteria were compared and analyzed. Results: premature delivery, low birth weight, stinking or fecal contamination of ewe, intrauterine distress, postnatal asphyxia, tracheal intubation were the high risk factors for premature neonatal sepsis. The clinical manifestations of neonatal septicemia were often atypical. The most common local infection was respiratory tract infection (91.2%), followed by skin mucosal infection (28.1%), and skin mucosal infection (28.1%). There was significant difference in the infection rate of skin and mucous membrane between the two groups (P < 0.05). In this group, 99.4% cases were complicated with other diseases, among which 49.1 cases of neonatal pathological jaundice were the most common cases of neonatal septicemia. The positive rate of bacterial culture was 49.1%, Gram-positive bacteria accounted for 74.1%, of which CONS accounted for 55.3% of the total strains and Mrs accounted for 49.4%; Gram-negative bacteria accounted for 23.5% of the total strains; Gram-producing gram-negative bacteria accounted for 11.8% of the total strains; fungi accounted for 2.40.Morning. There was significant difference in the infection rate of Gram-positive bacteria between the two groups (P < 0.05). The sensitivity of penicillin, erythromycin, cefoxitin, oxacillin and compound sulfamine to staphylococcus was low. Vancomycin was completely sensitive to gram-positive cocci, penicillin, cephalosporins and aztreonam were less sensitive to gram-negative bacteria, and the sensitivity of the third generation cephalosporins to gram-negative bacteria tended to decrease. Amikacin was sensitive to Gram-positive bacteria and Gram-negative bacteria, including ESBLs production. Conclusion: premature delivery, low birth weight, stink or fecal contamination of ewe water, intrauterine distress, postnatal asphyxia, Endotracheal intubation is a high risk factor for premature neonatal sepsis. Neonatal septicemia is often associated with local infection and various complications. There is significant statistical difference between early and late neonatal septicemia associated with local infection in our hospital. The positive rate of bacterial culture in pediatric patients was high. The main pathogenic bacteria were Gram-positive bacteria, especially CONS. Penicillin, erythromycin, cephalosporins, cefoxitin, oxacillin, aztreonam, and compound sulfamine were still the main pathogens of neonatal septicemia, and the resistance rates of penicillin, erythromycin, oxacillin, aztreonam and compound sulfamine were high. Is no longer suitable for neonatal sepsis as the preferred drug.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1

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