新生儿败血症260例临床分析

目的分析我所10年间新生儿败血症的临床和转归特点.方法对我所260例新生儿败血症患儿的临床资料和血培养阳性菌进行回顾性研究.结果新生儿败血症发病构成比和死亡构成比总体呈下降趋势.血培养结果显示凝固酶阴性葡萄球菌占44.7%,金黄色葡萄球菌14.9%,大肠埃希氏菌12.8%.病死率9.6%,发病日龄越小,病死率越高,≤3天发病者病死率高达22.5%.结论新生儿败血症的病死率仍然很高,防治工作有待进一步加强.     

568例新生儿败血症临床特征及病原菌情况分析

目的 探讨新生儿败血症早期诊断的临床思路及实验室方法。方法 对2002年11月～2006年5月568例新生儿败血症临床特点、病原菌及药物敏感情况进行回顾分析．了解血培养及外周血D反应蛋白（CRP）检测在新生儿败血症早期诊断中的价值。结果 （1）本组新生儿败血症占同期住院新生儿的5．4％，其中早发型败血症32．2％，临床症状重，常有中毒症状及并发症。（2）早产儿败血症发生率明显高于足月儿。（3）新生儿败血症的病原菌77．6％为葡萄球菌，其他依次为肠球菌、大肠杆菌。（4）血培养及外周血CRP检测可早期诊断新生儿败血症。（5）新生儿败血症20．7％并发化脓性脑膜炎，其他还有骨髓炎、眼内炎等。结论 败血症是新生儿时期常见危重症．并发症较多；血培养及外周血CRP可协助早期诊断，利于早期治疗。     

新生儿、未成熟儿

0235新生儿败血症79例临床分析罗玉桃广东医学2(9):11,1981作者报道本院于1976～1979年6月共收治79例新生儿败血症。以葡萄球菌败血症为多共49例,占血培养阳性病侧的89％。其中以白色葡萄球菌居多,固紫阴性杆菌较少,仅7例。     

新生儿败血症病原学探讨

本文报告了51例经血培养证实之新生儿败血症,重点对病原学的种类,药敏试验作了探讨,目的在于了解近6年来新生儿败血症的细菌特点,并找出各种细菌的敏感药物。 51例患儿男41例,女10例,死亡9例,病死率为17.6％。血培养结果葡萄球菌29例,占56.8％,居第一位,其中金葡菌15例     

细菌16S rRNA基因荧光定量PCR诊断新生儿败血症

目的探讨新生儿败血症的快速可靠诊断方法,以提高临床检测细菌的速度及准确性。方法以细菌16SrRNA基因为靶序列,设计通用引物及TaqMan探针,建立细菌16SrRNA基因实时荧光定量PCR反应体系;选择临床引起新生儿败血症的常见菌如金黄色葡萄球菌、表皮葡萄球菌和大肠埃希菌等进行浓度梯度实验;对临床疑为新生儿败血症的830例感染性疾病的新生儿抽取静脉血分别做细菌16SrRNA基因荧光定量PCR和血培养检测。结果临床常见分离株金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌荧光定量PCR检测结果均为阳性;巨细胞病毒、EB病毒、乙肝病毒,新型隐球菌及白色念珠菌,人基因组DNA及空白对照均为阴性。细菌荧光定量PCR最低能检测到3个细菌,其荧光定量CT值为37．90;对临床疑为感染性疾病的830例患儿标本中,荧光定量PCR检测血标本阳性率5．18％（43／830）,血培养阳性率2．41％（20／830）,前者明显高于后者,差异具有统计学意义,P〈0．01,30例非感染性疾病患儿血标本荧光定量PCR检测及细菌培养均为阴性。若以血培养作为对照,荧光定量PCR方法的诊断敏感性为100％,特异性为97．16％,正确诊断指数为0．972。结论建立了细菌16SrRNA基因荧光定量PCR诊断新生儿败血症方法。其检测快速、简便,为新生儿败血症提供早期、敏感的病原学诊断依据。     

新生儿金黄色葡萄球菌败血症55例临床分析

新生儿败血症是新生儿期的常见病。严重者可威胁新生儿生命。本文对我科1990年1月至1996年12月收治的经血培养证实的新生儿金黄色葡萄球菌败血症55例报道分析如下。临床资料一、一般资料根据1986年9月全国儿科杭州会议制定的《新生儿败血症诊断标准初步方案》选择经血培养确诊为金黄色葡萄球菌败血症者55例。其中男41例，女14例。入院体重＜2500克1例，余体重均在2500～4000克之间。全部为足月儿。发病日龄均在生后4天以上，4～7天2例。14天8例，～28天45例。有产时窒息史1例。二、临床资料发热49例（89．0％），体温不升3例（5．5％），吃…     

新生儿败血症的早期诊断(附43例分析)

新生儿败血症是新生儿期常见的重症疾病。为探讨该病的早期诊断对于降低病死率减少并发症的重要性，将我科收治的经血培养证实的43例新生儿败血症分析如下。资料与临床一、病例选择1988—1994年我院儿科病房收治的新生儿凡具有感染中毒症状，并经血培养，结果符合以下条件者：1）血培养两次以上阳性并为同一病原菌。2）血与脑脊液或其它病灶培养获同一病原菌。3）血培养一次阳性，病原菌为非条件致病菌。二、临床资料1．一般资料男24例女19例。早产儿2例足月儿41例，后者中3例小样儿3例为巨大儿。发病日龄≤3天者12例，≤7天25例，＞7天18…     

219例新生儿血培养阳性结果分析

新生地败血症是新生儿时期常见严重疾患，在新生儿感染疾患中发病率仅次于肺炎，占第二位。本文对92－94三年间的7O4例血培养中的219例阳性结果进行分析，旨在对新生地败血症的预防和治疗提供依据。一、方法与材料血液增菌液与血液比例为三0：I。细菌鉴定参照《全国临床检验操作规程》。药物敏感试验采用K一B氏法，标准菌株作质控对照。二、结果与讨论本组病例血培养阳性率31·1％（219／7O4）。见附表。国内报告新生儿败血症病原菌仍以革兰氏阳性球菌为主。本文试验结果表皮葡萄球菌占首位，为283％；其次为金黄色葡萄球菌，占21．5％，…     

108例新生儿败血症临床分析

新生儿败血症是新生儿期常见的危重疾病之一，严重威胁新生儿生命。其发生率占活产婴儿的1％～10％，病死率10～50％，临床表现缺乏特异性，血培养阳性率低。本文就我院1991年1月到2001年12月收治的临床诊断败血症108例作一分析。     

新生儿金黄色葡萄球菌败血症167例临床分析

临床资料：本文167例新生儿金黄色葡萄球菌（简称金葡菌）败血症为1992年3月至1993年2月收治，占同期新生地败血症（血培养阳性）之首位。男女比例为1．4：1，发病日龄＞3天58例，～ZI天109例。呼吸道起病占371％，脐部炎症占35，2％，皮肤感染占8．3％，产前或产时感染占5，9％，途径不明占13．l／。575％的病人临床表现少吃、少哭、少动，呕吐26．9％，伴腹胀9％，黄殖ZI．5％，体温异常22．7％，其中以体温不升为多．贫血13．8％，仅2．4％伴循环不良。外周血白细胞＞15X10’／L88例，＜10X10’／L21例，未成熟白细胞（主要指杆状核…     

晚发型新生儿败血症院内感染和社区感染的病原菌对比与分析

目的 晚发型败血症是新生儿期常见的感染性疾病,也是新生儿死亡的常见原因之一.新生儿一旦感染,病情可以迅速恶化,故早期有效的抗菌素治疗至关重要.该研究的目的 就是通过回顾性地分析晚发型新生儿败血症(LONS)的病原菌及其药敏,以指导临床早期对可疑LONS患儿合理用药.方法 对2002年1月1日至2005年12月31日温州医学院附属育英儿童医院NICU收住的具有临床表现以及至少一次血培养阳性的LONS临床特点、药敏进行回顾性分析.结果 102例LONS多通过皮肤、消化道、呼吸道等途径感染,临床表现无特异性.其中院内感染22例,社区感染80例,院内感染组与社区感染组比较,患儿胎龄小,体重轻,发病早(t=2.255、P＜0.01,t=8.818、P＜0.01,t=7.581、P＜0.05),差异有统计学意义.两组患儿血培养共检出110株病原菌,以凝固酶阴性葡萄球菌(CNS)居首(50/103,48.5%),其次为肺炎克雷伯杆菌(16/103,15.5%)、金黄色葡萄球菌(9/103,8.7%).社区感染主要病原菌为葡萄球菌属和大肠埃希菌,院内感染则为肺炎克雷伯菌.大部分(＞80%)的葡萄球菌尤其是CNS对青霉素类、红霉素及头孢唑啉耐药,MRSA达66.7%(6/9),但对万古霉素未发现耐药,大部分对利福平亦敏感.几乎所有(15/16)的ESBLS肺炎克雷伯菌具多重耐药性,仅对碳青霉烯类、氨基糖苷类以及喹诺酮类等少数抗菌药物敏感.发现1例对万古霉素耐药的粪肠球菌,然而,未发现B组链球菌感染的病例.结论 LONS临床表现非特异性,B组链球菌不是温州地区社区感染LONS的主要致病菌.由于医院和社区抗菌素的滥用,出现越来越多的多重耐药菌.对于可疑败血症患者应常规进行血培养以确定病原菌,并根据最可能的病原菌选用相关抗生素.为减少多重耐药菌感染的发生,应尽量减少第三代头孢菌素的使用.     

C-REACTIVE PROTEIN (CRP) IN EARLY DIAGNOSIS OF NEONATAL SEPTICEMIA

Abstract. The usefulness of CRP in early detection of neonatal septicemia/meningitis and urinary tract infection was studied in a neonatal unit using a semiquantitative latex-agglutination as a rapid screening method, and electroimmuno assay as reference method for CRP determination. In 94% of non-infected infants CRP was 15 mg/l and 82 % had CRP <10 mg/l up to 3 days of age. After 3 days of age 96% had CRP < 10 mg/l. The initial CRP level was increased in 16 out of 18 patients (89%) with bacterial septicemia. Low CRP was seen in one patient with total agranulocytosis and septicemia from Streptococcus type B and in one patient with Staphylococcus albus sepsis. A rise in CRP was also seen in very pre-term infants with septicemia. Increased initial CRP was uncommon in neonatal urinary tract infection (2 of 9), but a rise was seen in 3 additional patients. A comparison between CRP, total neutrophil blood cell count and band neutrophil count as diagnostic parameters was in favour of CRP at this early stage of infection. CRP is of definite value as an aid in early diagnosis of neonatal septicemia and bacterial meningitis.     

Bacteriological profile of neonatal septicemia

Fortyfive cases of blood culture positive neonatal septicemia treated during 1985 and 1986 were studied. Klebsiella was the most common causative organism (68.8%). This remained the predominant organism in early as well as late onset septicemia, in preterm as well as full term babies and in low birth weight as well as normal weight babies. Even in neonates referred to our hospital from outside and blood cultured on hospital admission, commonest causative bacteria was Klebsiella. The organism had a high order of in-vitro sensitivity to a gentamicin, streptomycin and cephaloridine. A combination of cephaloridine and gentamicin covered all the Klebsiella isolates. Overall mortality was 53.3%.     

Bacterial flora in mothers and babies with reference to causative agent in neonatal septicemia

One hundred newborns and their mothers were subjected to aerobic bacterial cultures and sensitivity study from different sites. Out of 36 clinically suspected neonatal septicemia cases, the blood culture was positive for bacterial growth in 24 neonates. The incidence of septicemia in PT-AGA, FT-AGA, FT-SFD and postterm-AGA babies was found to be 50.0, 13.5, 28.1 and 50.0%, respectively. The incidence of septicemia in LBW and FT-AGA babies was found to be 45.3 and 13.5%, respectively. The single major isolate in the positive blood culture was Staphylococcus aureus. In Gram positive septicemia the commonest site for colonization of the same organism in newborn was found to be umbilicus followed by nose, throat and external auditory canal, while in Gram negative septicemia rectum and umbilicus were the commonest sites.     

16SrRNA基因PCR加基因芯片杂交快速诊断新生儿败血症

目的　探讨新生儿败血症的快速诊断方法。方法　 (1)以 16SrRNA基因为靶序列 ,设计引物及寡核苷酸探针 ;将探针固定在特制的玻片上制作成基因芯片 ;(2 )对临床疑为细菌感染的 2 85例新生儿抽取静脉血分别做血培养和细菌 16SrRNA基因检测 :于血标本及脑脊液中抽提DNA后采用聚合酶链反应 (PCR)扩增 ,将扩增产物加样在基因芯片上杂交后进行激光扫描及读片。结果(1)PCR检测阳性率 5 96 % (17/2 85 )明显高于血培养的 2 81% (8/2 85 ) ,差异有显著意义 (P <0 0 1)。若以确诊败血症作为对照 ,PCR的诊断敏感性为 10 0 % ,特异性为 96 75 % ,正确诊断指数为 0 96 8。(2 )对 17份PCR阳性标本进一步做基因芯片杂交 ,结果通用探针均阳性 ,其中G 探针阳性 12份、G-探针阳性 5份 ;8份PCR和血培养均阳性的标本 ,基因芯片杂交探针阳性菌株与血培养细菌阳性结果完全一致。结论　基因芯片杂交技术检测临床标本中 16SrRNA基因能快速诊断新生儿败血症 ,除较血培养等方法有更好的敏感性和特异性外 ,还能快速明确系何种病原菌感染 ,因此有较大的推广及应用价值     

新生儿败血症外周血中性粒细胞CD64的表达及其意义

目的探讨外周血中性粒细胞CD64表达在新生儿败血症早期诊断中的价值.方法89例疑似败血症患儿,通过临床表现、血培养及5项非特异性指标白细胞、血小板、血浆C反应蛋白、微量血沉和未成熟中性粒细胞与中性粒细胞总数比值,分为败血症组39例和非败血症感染组50例.另设对照组19例.采用流式细胞仪检测外周血中性粒细胞CD64表达.结果败血症组患儿外周血中性粒细胞CD64表达率为(75.6±8.9)% ,显著高于非败血症感染组(29.1±6.2)%和对照组(5.1±1.1)%(P均<0.05) ,非败血症感染组与对照组比较差异也有统计学意义(P<0.05);革兰阴性菌败血症患儿CD64表达率(79.5 ±3.5)%高于革兰阳性菌败血症(76.4±4.6)%,但二者差异无统计学意义(P>0.05) ;败血症组经抗感染治疗后CD64表达水平下降.中性粒细胞CD64对新生儿败血症诊断的敏感性97.4%,特异性84.0%,阳性预测值82.6%,阴性预测值分别为97.6%.CD64检测阳性率62.9%(56/89)高于血培养19.1%(17/89)和5项非特异性指标29.2%(26/89)(P均<0.05).结论外周血中性粒细胞CD64测定可作为新生儿败血症早期诊断的指标,并可以判断疗效.     

C-reactive protein (CRP) in early diagnosis of neonatal septicemia.

The usefulness of CRP in early detection of neonatal septicemia/meningitis and urinary tract infection was studied in a neonatal unit using a semiquantitative latex-agglutination as a rapid screening method, and electroimmuno assay as reference method for CRP determination. In 94% of non-infected infants CRP was less than or equal to 15 mg/l and 82% had CRP less than 10 mg/l up to 3 days of age. After 3 days of age 96% had CRP less than 10 mg/l. The initial CRP level was increased in 16 out of 18 patients (89%) with bacterial septicemia. Low CRP was seen in one patient with total agranulocytosis and septicemia from Streptococcus type B and in one patient with Staphylococcus albus sepsis. A rise in CRP was also seen in very pre-term infants with septicemia. Increased initial CRP was uncommon in neonatal urinary tract infection (2 of 9), but a rise was seen in 3 additional patients. A comparison between CRP, total neutrophil blood cell count and band neutrophil count as diagnostic parameters was in favour of CRP at this early stage of infection. CRP is of definite value as an aid in early diagnosis of neonatal septicemia and bacterial meningitis.     

Changing Etiology and Outcome of Neonatal Septicemia in Riyadh, Saudi Arabia

ABSTRACT. To study the etiology of neonatal septicemia and factors associated with outcome, all charts of neonates with bacteremia and clinical sepsis admitted to a neonatal unit in Saudi Arabia, from 1 November 1980 to 31 October 1984 were reviewed. The results were compared to a previous study period in the unit (1 November 1976-31 October 1980). Septicemia was diagnosed on 50 occasions in 49 neonates. The incidence of neonatal sepsis among patients bom in the hospital was 2.5/1000 live births. Mortality from sepsis was 33% and was associated with neutropenia in 63%. The most commonly isolated bacteria were E. coli , Klebsiella and Staphylococcus aureus. Salmonella enteritidis serotypes were isolated in 4% of the cases. Group B streptococci (GBS) were isolated, for the first time, from blood of 3 neonates. Salmonella species were less frequently and GBS more often isolated than previously. GBS have now appeared as etiologic organisms in neonatal sepsis also in Saudi Arabia. Salmonella septicemia remains more common in Saudi Arabia than in the West.     

Changing etiology and outcome of neonatal septicemia in Riyadh, Saudi Arabia

To study the etiology of neonatal septicemia and factors associated with outcome, all charts of neonates with bacteremia and clinical sepsis admitted to a neonatal unit in Saudi Arabia, from 1 November 1980 to 31 October 1984 were reviewed. The results were compared to a previous study period in the unit (1 November 1976-31 October 1980). Septicemia was diagnosed on 50 occasions in 49 neonates. The incidence of neonatal sepsis among patients born in the hospital was 2.5/1,000 live births. Mortality from sepsis was 33% and was associated with neutropenia in 63%. The most commonly isolated bacteria were E. coli, Klebsiella and Staphylococcus aureus. Salmonella enteritidis serotypes were isolated in 4% of the cases. Group B streptococci (GBS) were isolated, for the first time, from blood of 3 neonates. Salmonella species were less frequently and GBS more often isolated than previously. GBS have now appeared as etiologic organisms in neonatal sepsis also in Saudi Arabia. Salmonella septicemia remains more common in Saudi Arabia than in the West.