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目的对比分析社区感染与院内感染所致新生儿败血症晚发型(Late-Onset Sepsis,LOS)的临床特点、病原菌分布及药敏情况,为临床早期合理诊治提供依据。方法选择某院2009年1月至2013年12月收治的168例新生儿败血症晚发型的临床资料,按照发生地点分为社区感染病例123例,院内感染病例45例,进行对比统计分析。结果低体温、黄疸在社区感染组多见;腹胀、呼吸暂停在院内感染组多见;两组非特异性指标改变无差异;血培养阳性率及病原菌构成无差异;主要病原菌为凝固酶阴性葡萄球菌(CONS)21例(35.0%),大肠埃希菌15例(25.0%),金黄色葡萄球菌11例(18.3%);凝固酶阴性葡萄球菌对常用抗菌药物的耐药率较高,对万古霉素敏感,对比两组无统计学差异;社区感染组大肠埃希菌对头孢唑林、头孢他啶、头孢曲松和头孢哌酮的耐药率明显低于院内感染组,对亚胺培南、美罗培南敏感。结论社区感染与院内感染新生儿败血症晚发型在临床表现、非特异性指标及病原菌分布及耐药率各有不同,临床应根据不同特点争取早期诊断、合理治疗。
Objective To compare and analyze the clinical features, pathogen distribution and drug susceptibility of neonatal sepsis late-onset (Late-Onset Sepsis, LOS) caused by nosocomial infection and nosocomial infection in order to provide the basis for reasonable early diagnosis and treatment. Methods One hundred and seventy-eight cases of neonatal sepsis with late-onset neonatal seizures were selected from January 2009 to December 2013 in our hospital. 123 cases of community infection and 45 cases of nosocomial infections were divided according to the site of occurrence. Statistical analysis was performed. Results Low body temperature and jaundice were common in community infection group. Bloating and apnea were more common in nosocomial infection group. There was no difference in non-specific index between the two groups. There was no difference in the positive rate of blood culture and pathogen composition. The main pathogens were coagulase negative staphylococcus (CONS) in 21 cases (35.0%), Escherichia coli in 15 cases (25.0%) and Staphylococcus aureus in 11 cases (18.3%). Coagulase-negative staphylococci had a high resistance rate to common antibiotics, The sensitivity of Escherichia coli to cefazolin, ceftazidime, ceftriaxone and cefoperazone in community infection group was significantly lower than that in nosocomial infection group, Meropenem sensitive. Conclusion The clinical manifestations, nonspecific indexes, distribution of pathogens and drug resistance rate of neonatal sepsis with community infection and nosocomial infection are different. Clinic should strive for early diagnosis and reasonable treatment according to different characteristics.