新生儿败血症46例临床特征与病原菌分析

目的探讨新生儿败血症的临床特点、病原菌构成及抗生素耐药性,指导临床诊治。方法对2009—10—2013-01该院1560例住院新生儿中血培养阳性的46例新生儿败血症患儿进行回顾性分析。结果新生儿败血症临床表现缺乏特异性。血培养结果以葡萄球菌为主要致病菌,药敏试验发现大多数菌株对青霉素和氨苄西林耐药,对第一、二代头孢菌素类大部分耐药,对第三代头孢菌素类、舒巴坦、氨基糖甙类和喹诺酮类较敏感,对亚胺培南、万古霉素、替考拉宁高度敏感。结论新生儿败血症临床表现缺乏特异性,病原菌以革兰氏阳性菌为主,监测病原菌耐药性变迁,根据药敏试验结果选用药物,对指导临床防治新生儿败血症具有重要的意义。     

新生儿败血症94例病原及药物敏感试验分析

目的 探讨新生儿败血症的病原及药物敏感情况，以指导治疗，提高疗效。方法 对我院近5年来收住的94例血培养阳性，确诊为新生儿败血症的病原菌和抗菌药物敏感性进行分析。结果 病原菌以葡萄球菌为主，共69例(73．40％)，其中表皮葡萄球菌26例(27．66％)、溶血性葡萄球菌14例(14．89％)、金黄色葡萄球菌12例(12．77％)。其次为大肠埃希菌10例(占10．63％)。青霉素、氨苄青霉素基本耐药，含β—内铣胺酶抑制剂的药物(氨苄西林舒巴坦、头孢三、四代坑生素)、亚胺培南、万古霉素、丁胺卡那霉素、环丙沙星敏感率高。结论 根据血培养药敏结果选用敏感坑菌药物，可减少细菌耐药性的产生，提高临床治疗效果。     

川崎病的早期诊断和鉴别诊断

目的研究川崎病（KD）患儿的临床特点，以提高其早期诊断率。方法采用前瞻性临床观察研究方法，分析67例川崎病患儿入院时临床表现和实验室检查，并与同期收治的329例败血症患儿进行对比。结果川崎病诊断标准中的6种临床表现及肛周变化在川崎病中的出现率均显著高于败血症，而精神差、循环差、肝脾大及局灶感染征的出现率在败血症中均显著高于川崎病（均P〈0．01）。球蛋白升高、ESR增快、血小板升高在川崎病中的出现率均显著高于败血症，血培养阳性率在败血症中显著高于川崎病（均P〈0．01）。结论早期诊断川崎病的关键是与败血症相鉴别；认真仔细的病史问诊和体格检查很重要。     

武汉市某医院新生儿院内败血症调查

目的：了解新生儿院内败血症的流行病学特征,为制定有效的防治措施提供科学依据。方法：采用回顾性调查方法收集2004年1月-2012年12月武汉市某医院新生儿病房患儿的相关资料,并进行统计分析。结果：新生儿院内败血症发病率明显下降,凝固酶阴性葡萄球菌、肠球菌及真菌感染明显增加,耐苯唑西林的葡萄球菌检出率显著增加,危险因素更多与侵入性操作相关。结论：新生儿院内败血症的发病率、致病菌分布及其耐药性以及危险因素均已发生了变迁,医院应对其进行动态监测,及时掌握其变化趋势,才能更好地有效防治。     

Septicemia in Immunocompromised Children and Their Intestinal Flora

Quantitative fecal bacteriology was performed in eight immunocompromised children with septicemia. The most marked change observed was suppression of the anaerobic bacteria. In seven patients, the predominant organisms were aerobic gram-negative bacilli (GNB), and in six of these were the same as the causative organism of the septicemia. Thus, overgrowth of GNB in the gastrointestinal tract may result in invasion of the blood stream and septicemia in immunocompromised patients. To prevent this complication it is necessary to allow the normal intestinal flora to be maintained in these patients as long as possible. Antibiotics should therefore be prescribed with caution. For the same reason, use of immunosuppressive drugs should be kept to a minimum. Bacteriological examination of the stool and pharynx is useful in the management of immunocompromised patients.     

新生儿败血症的分析与护理对策(附73例分析)

对 73例新生儿败血症患儿作了回顾性分析 ,认为新生儿败血症的病因多与脐炎及皮肤感染有关 ,为此提出实行床边隔离、维持体温稳定、处理原发病灶、保证有效的血药浓度等护理对策。结果 :73例新生儿败血症患儿 ,治愈 6 6例 ,病情好转自动出院 4例 ,死亡 3例     

Septicemia in the newborn due to gram-negative bacilli

The case histories of 17 newborns developing septic shock due to gram-negative bacilli were studied for pre- and perinatal risk factors, clinical symptoms, and hematologic changes.Immaturity, resuscitation procedures, and hypothermia on admission were found to be the risk factors most frequently preceding septicemia. A skin color fading and changing from reddish-pink to yellow-green was the most early noticeable clinical symptom in all patients. The total leukocyte counts as well as the relative proportion of bands increased significantly at the onset of illness. When septicemia advanced, a marked drop of leukocytes was found, while the relative proportion of bands increased further. Only 1 in 12 cases showed a decrease in the platelet counts at the height of septicemia.A procedure for the early diagnosis of a neonatal septicemia is proposed: (1) Registration of perinatal risk factors. (2) With perinatal risk factors a skilled and attentive clinical observation is necessary. Particular attention should be paid to changes of skin color. (3) White blood cell picture: (a) every day in patients with perinatal risk factors and (b) every 6 h in patients showing suspicious symptoms.