124例新生儿败血症的临床特点和病原学分析

目的:分析新生儿败血症的临床特点、病原学。方法:对2013年3月至2017年2月濉溪县医院儿科124例血培养阳性的新生儿败血症临床资料回顾性分析，并依据败血症发病时间将病例分为早发型组和晚发型组，比较2组之间的差异。结果:住院新生儿败血症占同期住院新生儿的3.4%（124/3634）。其中早发型占54.8%（68/124），主要表现黄疸，呻吟、青紫、呼吸困难、反应低下，C反应蛋白增高；晚发型败血症占45.2%（56/124），主要表现发热、气促、黄疸，合并局部感染灶；早发型组羊水污染和胎膜早破发生率高于晚发型组（P<0.05）；早发型组黄疸、呻吟、青紫、呼吸困难、反应低下的发生率均明显高于晚发型组（P<0.01）；早发型组肺炎、合并局部感染灶的发生率低于晚发型组（P<0.01和P<0.05）。败血症致病菌中，革兰阳性菌占88.7%，革兰阴性菌占11.3%；革兰阳性菌对夫西地酸、万古霉素、米诺环素高度敏感，革兰阴性菌对碳青霉烯类高度敏感。结论:早发型和晚发型新生儿败血症临床表现各有特点，早发型临床症状较重；葡萄球菌及大肠埃希菌是我院儿科新生儿败血症主要病原菌，临床医生根据其临床特点及常见致病菌选择抗生素，再据血培养结果及药敏结果调整抗生素。

Analysis of the clinical features and etiology in 124 neonatal septicemia cases

Objective: To analyze the clinical and etiologic features of neonatal septicemia.Methods: The clinical data of 124 neonatal septicemia cases from March 2013 to February 2017 were retrospectively analyzed.The patients were divided into the early onset group and late onset group according to the onset time,and the difference between two groups was compared.Results: The ratio of neonatal septicemia cases to the hospitalized newborns at the same time was 3.4%(124/3634),54.8% of which was the early onset type,and the major performances of which were jaundice,groans,cyanosis,dyspnea,responsiveness decreasing and C-reactive protein increasing.The 45.2% of patients were the late onset type,and the major performances of which were fever,dyspnea,jaundice,and focal infection.The incidence rates of the premature rupture of fetal membrane and amniotic fluid pollution in early onset group were higher than those in late onset group(P<0.05),the incidence rates of jaundice,groan,cyanosis,dyspnea and poor response in early onset group were significantly higher than those in late onset group(P<0.01).The incidence rate of the pneumonia complicated with focal infection in early onset group was lower than that in late onset group(P<0.01 and P<0.05).Among the septicaemic pathogens,88.7% of which was gram-positive bacteria,and 11.3% of which was gram-negative bacteria.The gram-positive bacteria was highly sensitive to vancomycin,minocycline and fusidic acid,and the gram-negative bacteria was highly sensitive to carbapenems.Conclusions: The clinical features between early onset and late onset neonatal septicemia are different,and the early onset disease is severe.The staphylococcus and escherichia coli are the main pathogens of septicemia.The clinical features and main pathogens of septicemia are the reference in antibiotics use,and the adjustment of antibiotics should accord to the bacterial culture result and drug sensitivity.