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极低出生体重儿败血症的临床分析
A clinical analysis of sepsis in very low birth weight infants
目的 分析极低出生体重儿败血症的发生情况及临床特征。方法 收集2019年1月至2020年6月南京医科大学附属妇产医院新生儿科收治的极低出生体重儿（出生体重 < 1 500 g）的临床资料，分析败血症发生率、病原菌分布及危险因素。结果 共369例患儿纳入研究，其中败血症138例，包括早发型败血症（early-onset sepsis，EOS）84例、晚发型败血症（late-onset sepsis，LOS）54例。EOS患儿病原菌以粪肠球菌（24%）、链球菌类（21%）为主，LOS患儿病原菌以葡萄球菌类（41%）、肠杆菌类（29%）为主。EOS及LOS的发生率均随着出生胎龄、出生体重的升高而降低（P < 0.05）。多因素logistic回归分析显示，出生体重高是EOS的保护因素（OR=0.996，95%CI：0.993~0.998，P < 0.05），阴道分娩是EOS的危险因素（OR=2.781，95%CI：1.190~6.500，P < 0.05）；肠外营养时间长是LOS的危险因素（OR=1.129，95%CI：1.067~1.194，P < 0.05）。结论 粪肠球菌是极低出生体重儿EOS最常见的病原菌，而LOS的病原菌以葡萄球菌类最为常见。出生体重高可降低极低出生体重儿EOS发生的风险，而阴道分娩可能增加EOS的发生风险；肠外营养时间长可能增加LOS的发生危险。
Objective To study the incidence and clinical features of sepsis in very low birth weight (VLBW) infants. Methods The clinical data were collected from VLBW infants, with a birth weight of < 1 500 g, who were admitted to the Department of Neonatology, Maternity Hospital Affiliated to Nanjing Medical University, from January 2019 to June 2020. The incidence of sepsis, distribution of pathogenic bacteria, and risk factors for sepsis were analyzed. Results A total of 369 infants were enrolled, and 138 infants had sepsis, among whom 84 had early-onset sepsis (EOS) and 54 had late-onset sepsis (LOS). Enterococcus faecalis (24%) and Streptococcus (21%) were the main pathogenic bacteria in infants with EOS, and Staphylococcus (41%) and Enterobacter (29%) were the main pathogenic bacteria in infants with LOS. The incidence of EOS and LOS decreased with the increase of gestational age and birth weight (P < 0.05). The multivariate logistic regression analysis showed that a high birth weight was a protective factor against EOS (OR=0.996, 95%CI:0.993-0.998, P < 0.05), while vaginal delivery (OR=2.781, 95%CI:1.190-6.500, P < 0.05) was a risk factor for EOS, and long duration of parenteral nutrition was a risk factor for LOS (OR=1.129, 95%CI:1.067-1.194, P < 0.05). Conclusions Enterococcus faecalis is the most common pathogenic bacteria for EOS, and Staphylococcus is the most common pathogenic bacterium for LOS in VLBW infants. A high birth weight may reduce the risk of EOS in VLBW infants, while vaginal delivery may increase the risk of EOS. Prolonged parenteral nutrition may increase the risk of LOS.
早发型败血症 / 晚发型败血症 / 危险因素 / 病原菌 / 极低出生体重儿
Early-onset sepsis / Late-onset sepsis / Risk factor / Pathogenic bacteria / Very low birth weight infant
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六个一工程拔尖人才资助项目（LGY2019008）；南京市医学科技发展基金（ZKX19045）；南京医科大学“专病队列”资助项目（NMUC2020037）；江苏省333人才工程。
