新生儿败血症83例临床分析

目的:了解引起新生儿败血症的主要细菌分布及抗生素敏感情况,动态观察白细胞计数(WBC)、C-反应蛋白(CRP)、血小板计数(PLT)、白介素-6(IL-6)的变化情况,以指导临床治疗。方法:回顾性分析83例新生儿败血症血培养及药敏试验结果,另选同期无感染症状的81例新生儿作为对照组,测定新生儿败血症组治疗前后以及对照组WBC、CRP、PLT、IL-6,比较相互间差异。结果:83例新生儿败血症患儿大肠埃希菌27例,肺炎克雷伯菌20例,金葡菌14例,绿脓假单胞菌11例,粪肠球菌7例,阴沟肠杆菌4例。大肠埃希菌对碳青霉烯类高度敏感,其次为阿米卡星和3代头孢菌素;肺炎克雷伯菌对碳青霉烯类高度敏感,其次分别为环丙沙星、庆大霉素,对3代头孢菌素普遍耐药,同时对头孢吡肟普遍耐药;金葡菌对万古霉素高度敏感,其次为碳青霉烯类;绿脓假单胞菌对碳青霉烯类高度敏感;粪肠球菌对万古霉素高度敏感,对亚胺培南耐药;阴沟肠杆菌对碳青霉烯类高度敏感。败血症组治疗前CRP阳性率为71.1%,IL-6、CRP、WBC明显高于对照组和恢复期,PLT明显低于对照组和恢复期,与对照组CRP、WBC、PLT计数比较均有明显差异(P<0.001)。83例败血症患儿中治愈61例,好转15例,7例病情无好转家属放弃治疗自动出院,其中4例自动出院后死亡。结论:治疗新生儿败血症时应根据药敏结果选用敏感抗生素治疗,同时动态观察WBC、CRP、PLT、IL-6的变化以反映细菌感染的消退情况,弥补因细菌培养阳性率低及培养周期长的缺陷,有效地控制疾病的发展。

Clinical analysis of 83 neonates with septicemia

Objective:To explore main bacterial distribution and antibiotics sensitivity of neonatal sepsis,and dynamic changes of WBC,CRP,PLT and IL-6t.Methods:Septicemia blood culture and drug sensitive test results of 83 cases with neonatal sepsis were retrospectively analyzed.And another 81 infants without symptoms of infection during same time were selected as control group.WBC,CRP,PLT and IL-6 were determined before and after treatment.Results:Among 83 cases of neonatal sepsis,there were 27 cases with Escherichia coli,20 cases with Klebsiella pneumonia,14 cases with Staphylococcus aureus bacteria,11 cases with Pseudomonas aeruginosa,7 cases with Enterococcus faecalis,and 4 cases with Enterobacter cloacae.Escherichia coli was highly sensitive to carbapenems,followed by amikacin and the 3rd generation cephalosporins;Klebsiella pneumoniae was highly sensitive to carbapenems,followed by ciprofloxacin,gentamicin,generally resistant to the 3rd generation cephalosporins and to cefepime at the same time.Staphylococcus aureus was highly sensitive to vancomycin,followed by carbapenems.Pseudomonas aeruginosa was highly sensitive to carbapenems.Enterococcus faecalis was highly sensitive to vancomycin,and resistant to imipenem,Enterobacter cloacae was highly sensitive to the carbapenems.Before treatment the rate of CRP positive in the sepsis group was 71.1%.IL-6,CRP,WBC in sepsis group before treatment were significantly higher than that in the control group and that of sepsis group during recovery period;PLT was significantly lower than the control group and that of sepsis group during recovery period.There were significant differences in CRP,WBC and PLT between two groups.A total of 61 cases were cured,and 15 cases were improved;besides,7 cases were discharged without improvement,of which 4 cases died.Conclusion:The treatment of neonatal sepsis should be selected according to drug sensitivity test.At the same time,the changes of WBC,CRP,PLT and IL-6 should be closely monitored to observe the status of the bacterial infection.It can compensate defect due to low positive rate of bacterial culture and long culture cycle,and control the disease development effectively.