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目的对比分析早发型(EOS)和晚发型(LOS)新生儿脓毒症的易感因素、感染途径、临床表现、实验室检查、病原菌分布及耐药情况,为临床提供诊治依据。方法对2008年6月-2011年6月本院新生儿科收治的新生儿脓毒症178例(EOS 79例,LOS99例)进行回顾性分析。结果新生儿脓毒症感染途径以呼吸道、皮肤、脐部为主。EOS组以黄疸(36例)、呼吸道症状(60例)多见,LOS组以发热(50例)多见;EOS组PLT降低(28例)较LOS组(9例)多见,WBC、CRP异常及血培养阳性率2组间差异无统计学意义。新生儿脓毒症血培养阳性共102例(占51.5%),病原菌以葡萄球菌为主[共67例(占65.5%)],其中耐甲氧西林凝固酶阴性葡萄球菌36例(占53.7%);EOS组革兰阴性细菌(19例)较LOS组(11例)多见,其中超广谱β内酰胺酶阳性菌14例(占13.7%)。EOS组脓毒症合并细菌性脑膜炎(17例)、DIC(12例)、坏死性小肠结肠炎(10例)较LOS组(分别为8例、6例、4例)多见,EOS组病死率(19.0%)高于LOS组(7.1%)。结论新生儿脓毒症病死率较高,临床表现缺乏特异性,目前尚缺乏特异有效的检测方法。病原菌以葡萄球菌为主,耐药菌和条件致病菌有增多趋势。早期诊断、合理使用抗生素、防治严重并发症是治愈新生儿脓毒症的关键。
Objective To compare and analyze the predisposing factors, infection ways, clinical manifestations, laboratory tests, pathogen distribution and drug resistance of sepsis in neonates with early-onset (EOS) and late-onset (LOS) Methods 178 neonates with sepsis (79 cases of EOS and 99 cases of LOS) admitted to neonatology department of our hospital from June 2008 to June 2011 were analyzed retrospectively. Results neonatal sepsis infection in respiratory tract, skin, umbilical mainly. In EOS group, jaundice (36 cases) and respiratory symptoms (60 cases) were more common. LOS group was more common in fever (50 cases). EOS group had lower PLT (28 cases) than LOS group (9 cases) There was no significant difference between the two groups in abnormality and blood culture positive rate. A total of 102 cases (51.5%) were positive for blood culture of neonatal sepsis, Staphylococcus aureus was the predominant pathogens (67 cases (65.5%)], of which 36 cases were methicillin-resistant coagulase negative staphylococci (53.7% ). Gram-negative bacteria in EOS group (19 cases) were more common than LOS group (11 cases), of which 14 cases (13.7%) were ESBLs-positive bacteria. Sepsis with bacterial meningitis (17 cases), DIC (12 cases) and necrotizing enterocolitis (10 cases) were more common in EOS group than in LOS group (8 cases, 6 cases and 4 cases, respectively) The case fatality rate (19.0%) was higher than that in the LOS group (7.1%). Conclusion neonatal sepsis mortality is high, the lack of specificity of clinical manifestations, there is still no specific and effective detection methods. Staphylococcus aureus-based pathogens, resistant bacteria and pathogens have an increasing trend. Early diagnosis, rational use of antibiotics, prevention and treatment of serious complications is the key to cure neonatal sepsis.