革兰阳性菌及革兰阴性菌所致新生儿社区获得性败血症晚发型临床分析

目的：探讨革兰阳性菌及革兰阴性菌所致新生儿社区获得性败血症晚发型的临床特点及药敏情况。方法：收集我院2009年1月至2012年12月收治的83例致病菌为革兰阳性菌和革兰阴性菌的新生儿社区获得性败血症晚发型的临床资料，进行回顾性分析。结果：83例新生儿社区获得性败血症晚发型中革兰阳性菌53例，占63．9％，以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主；革兰阴性菌30例，占36．1％，以大肠埃希菌为主。检出的革兰阳性菌对红霉素、青霉素敏感率最低，对左氧氟沙星、庆大霉素、四环素部分敏感，万古霉素高度敏感。检出的革兰阴性菌对头孢噻吩、氨苄青霉素敏感率较低，对头孢他定、头孢曲松、环丙沙星、庆大霉素部分敏感，美罗培南高度敏感。革兰阳性菌感染多见于足月儿，革兰阴性菌感染多见于早产儿，对比两组围产情况无统计学差异，临床表现缺乏特异性。脐部感染多引起革兰阳性菌败血症。血小板降低多见于革兰阴性菌败血症，而在白细胞、杆状核细胞/中性柱细胞、CRP 上无差异。结论：新生儿社区获得性败血症晚发型临床表现无特异性，早期诊断需结合胎龄、感染部位、非特异性指标变化，抗生素应用应依据药敏结果。

Clinical Analysis of Late-onset Neonatal Community Acquired Sepsis Caused by Gram-positive and Gram-negative Bacteria

Objective：To explore the clinical characteristics of late-onset neonatal community acquired sepsis caused by gram-positive and gram-negative bacteria and the drug susceptibility .Method： Collected the clinical data of 83 cases of late-onset neonatal community acquired sepsis , which were hospitalized between January 2009 and December 2012 in our hospital , and were caused by gram-positive and gram-negative bacteria.Result：There were 53 cases （63.9%）caused by gram positive bacteria in 83 cases, mainly the coagulase negative staphylococcus and staphylococcus aureus , another 30 cases （ 36.1%） were caused by gram negative bacteria , primary the e.coli.The gram positive bacteria had the lowest sensitivity to erythro-mycin , penicillin , and were partially sensitive to levofloxacin , gentamycin , and tetracycline , but were highly sensitive to vancomycin .The gram-negative bacteria detected had a lower sensitivity to cefalotin and ampicil-lin, and were partially sensitive to cephalosporin , ceftriaxone, ciprofloxacin and gentamycin , but were highly sensitive to meropenem .Gram-positive bacteria mostly infected full term infants , and gram-negative bacteria infection mainly happened in premature infants , there was no statistical difference in perinatal situation of the two groups, and were lack of specificity in clinical manifestations .Navel infection usually resulted in gram-positive bacteria septicemia .PLT decreased often in gram-negative bacteria sepsis , but there was no difference in WBC , I/T and CRP .Conclusion：Lateonset neonatal community acquired sepsis are lack of specificity in clinical manifestations , early diagnosis should be combined with the gestational age , the most commonly infected site , and changes of the nonspecific index , application of antibiotics should be according to the results of drug susceptibility .