目的 分析比较革兰阳性菌(G+)、革兰阴性菌(G-)和真菌所致新生儿败血症的临床特征和住院费用.方法 对236 例新生儿败血症患儿的临床资料进行回顾性分析,包括G+ 菌败血症110 例,G-菌败血症68 例,真菌败血症58 例.结果 G+ 菌组足月儿占62%,G-菌组足月儿占38%,真菌组早产儿占86%,真菌组新生儿的胎龄、出生体重小于G+ 菌组和G-菌组(P<0.05).G-菌组、真菌组中多胎所占比例高于G+ 菌组(P<0.0125).G-菌组胎膜早破>18 h、羊水Ⅲ度污染、早发型败血症的比例均高于G+ 菌组和真菌组(P<0.0125).G+ 菌组起病症状为体温异常、脐炎或疱疹的患儿比例高于G-菌组和真菌组(P<0.0125).真菌组呼吸暂停的发生率高于G+ 菌组和G-菌组(P<0.0125).真菌组血小板降低的发生率高于G+ 菌组和G-菌组(P<0.0125).真菌组住院时间长于G+ 菌组和G-菌组(P<0.05),住院总费用高于G+ 菌组和G-菌组(P<0.05).结论 G+菌败血症以足月儿为主;G-菌败血症多见于早发型;真菌败血症多见于早产儿和低出生体重儿,易发生呼吸暂停、血小板减少,且住院时间和住院费用高于细菌败血症.
Abstract
Objective To study the clinical features and hospital costs of neonatal sepsis caused by Gram-positive (G+) bacteria, Gram-negative (G-) bacteria, and fungi. Methods The clinical data of 236 neonates with sepsis were analyzed retrospectively. Among these neonates, 110 had sepsis caused by G+ bacteria, 68 had sepsis caused by G- bacteria, and 58 had sepsis caused by fungi. Results Full-term infants accounted for 62% and 38%, respectively, in the G+ bacteria and G- bacteria groups, and preterm infants accounted for 86% in the fungi group. The neonates in the fungi group had significantly lower gestational ages and birth weights than those in the G+ and G- bacteria groups (P<0.05). Compared with the G+ bacteria group, the G- bacteria and fungi groups had significantly higher rates of multiple births (P<0.0125). Compared with the G+ bacteria and fungi groups, the rates of premature rupture of membranes >18 hours, grade III amniotic fluid contamination, and early-onset sepsis in the G- bacteria group were significantly higher (P<0.0125). Compared with the G- bacteria and fungi groups, the G+ bacteria group showed significantly higher rates of abnormal body temperature, omphalitis or herpes as the symptom suggesting the onset of such disease (P<0.0125). The fungi group had significantly higher incidence rates of apnea and low platelet count than the G+ and G- bacteria groups (P<0.0125). The comparison of length of hospital stay and total hospital costs between any two groups showed that the fungi group had a significantly longer hospital stay and significantly higher total hospital costs than the G+ and G- bacteria groups (P<0.05). Conclusions Sepsis caused by G+ bacteria mainly occurs in full-term infants, and most cases of sepsis caused by G- bacteria belong to the early-onset type. Sepsis caused by fungi is more common in preterm infants and low birth weight infants, and has high incidence rates of apnea and low platelet count, as well as a longer hospital stay and higher hospital costs than sepsis caused by bacteria.
关键词
败血症 /
病原菌 /
住院费用 /
新生儿
Key words
Sepsis /
Pathogenic bacteria /
Hospital costs /
Neonate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 余加林, 吴仕孝. 败血症[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4 版. 北京: 人民卫生出版社, 2011: 340-347.
[2] Shane AL, Stoll BJ. Neonatal sepsis: progress towards improved outcomes[J]. J Infect, 2014, 68(Suppl 1): S24-S32.
[3] 中华医学会儿科学分会新生儿学组; 中华医学会中华儿科杂志编辑委员会. 新生儿败血症诊疗方案[J]. 中华儿科杂志, 2003, 41(12): 897-899.
[4] Kocabas E, Sarikcioglu A, Aksaray N, et al. Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis[J]. Turk J Pediatr, 2007, 49(1): 7-20.
[5] Kangozhinova K, Abentayeva B, Repa A, et al. Culture proven newborn sepsis with a special emphasis on late onset sepsis caused by Enterobacteriaceae in a level III neonatal care unit in Astana, Kazakhstan[J]. Wien Klin Wochenschr, 2013, 125(19-20): 611-615.
[6] de Assis Meireles L, Vieira AA, Costa CR. Evaluation of the neonatal sepsis diagnosis: use of clinical and laboratory parameters as diagnosis factors[J]. Rev Esc Enferm USP, 2011, 45(1): 33-39.
[7] 杨静, 华子瑜. NICU 医院感染及其防治[J]. 临床儿科杂志, 2014, 32(9): 808-811.
[8] 彭敬红, 吕军, 吴均竹, 等. 凝固酶阴性葡萄球菌致新生儿败血症的耐药性分析[J]. 中华医院感染学杂志, 2011, 21(5): 1034-1036.
[9] Kime T, Mohsini K, Nwankwo MU, et al. Central line ""attention"" is their best prevention[J]. Adv Neonatal Care, 2011, 11(4): 242-248.
[10] 刘前芳, 陈新红, 张先红, 等. 220 例极低出生体质量儿医院感染的临床分析[J]. 第三军医大学学报, 2013, 25(5): 451-455.
[11] Long SS, Stevenson DK. Reducing Candida infections during neonatal intensive care: management choices, infection control, and fluconazole prophylaxis[J]. J Pediatr, 2005, 147(2): 135-141.
[12] 马莉, 袁卉屏. 132 例早产儿呼吸暂停临床分析[J]. 中国妇幼保健, 2008, 23(31): 4426-4427.
[13] Warris A, Semmekrot BA, Voss A. Candidal and bacterial bloodstream infections in premature neonates: a case-control study[J]. Med Mycol, 2001, 39(1): 75-79.
[14] 花少栋, 吴志新, 黄捷婷, 等. 早产儿白假丝酵母菌败血症 13 例临床分析[J]. 中国当代儿科杂志, 2012, 14(10): 728-732.
[15] 徐豆豆, 王杨, 藏建业, 等. 新生儿重症监护病房内早产儿真菌脓毒症危险因素临床分析: 2010 年至2012 年单中心报告[J]. 中华实用儿科临床杂志, 2013, 28(18): 1393-1397.
基金
安徽省自然科学基金面上项目(1308085MH150);安徽省高等学校省级自然科学研究项目(KJ2013A167).