早产儿医院感染败血症的临床特点与病原学分析

目的调查分析早产儿医院感染败血症的临床特点、病原菌分布及药敏情况。方法回顾性分析我院新生儿科2007年1月至2011年12月发生医院感染败血症的早产儿病例。结果研究期间共出院早产儿5660例,排除染色体异常和住院时间小于5天的病例,纳入分析5392例,发生医院感染败血症81例,发生率1.5%,共治愈60例,治愈率74.1%。发病时表现多种多样,最常见的实验室指标异常是C反应蛋白（CRP）升高。病原菌以革兰阴性菌最多见（57.6%）,真菌占第二位（30.3%）。其中,革兰阴性杆菌以肺炎克雷伯菌为主,对大部分β内酰胺类抗生素耐药;革兰阳性菌以表皮葡萄球菌为主,大多对青霉素耐药,对万古霉素敏感;真菌感染均为念珠菌,对氟康唑、两性霉素B均敏感。结论早产儿医院感染败血症临床表现各异,CRP升高是较敏感的指标。致病菌主要为革兰阴性菌和真菌,革兰阴性菌对大部分β-内酰胺类抗生素耐药。

Evaluation and analysis of nosocomial sepsis in preterm infants

Objective To evaluate the clinical characteristics and the pathogen distribution in preterm infants with nosocomial sepsis. Methods A retrospective chart review was conducted. The data of all hospitalized preterm infants with nosocomial sepsis from January 2007 to December 2011 were collected and analyzed （n = 5392 ）. Results In the study cohort, nosocomial sepsis occurred in 81 preterm infants. The incidence was 1.5%. Among those 81 cases, 60 preterm infants were cured. The clinical presentations were various and non-specific. Increased CRP levels were the most common laboratory markers of nosocomial sepsis. The leading The main pathogen of gram-negative organisms was pathogens were gram negative bacteria and fungi. Klebsiella and the main pathogen of gram-positive organisms was Staphylococcus epidermidis. Candida was responsible for all fungal sepsis. Most gram-negative organisms were resistant to common-lactam antibiotics. Most gram-positive organisms were resistant to penicillin and sensitive to vancomycin. All of the fungi were sensitive to fluconazole and amphotericin B. Conclusions The clinical presentations of nosocomial sepsis are various and non-specific. Increased CRP level is a sensitive laboratory marker. The main pathogens are Gram negative bacteria and fungi.