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目的:探讨NICU新生儿败血症的临床特点、病原菌分布和药物敏感状况。方法:回顾性分析中山大学附属第一医院NICU1998年1月~2007年12月确诊的34例败血症新生儿的临床资料。结果:34例新生儿均有程度不等的少吃、少哭、少动和体重不长,发热20例,休克10例,黄疸加重或延长9例,呼吸暂停7例,喂养不耐受6例,合并局部感染10例。动态血象显示WBC<5×109/L(41.18%)比WBC>20×109/L(8.82%)更普遍(P<0.05),起病时WBC和血小板计数均显著下降(P<0.05);CRP>8 mg/L17例(17/24,70.83%),CRP≤8 mg/L 7例(7/24,29.17%)。7例(29.17%)C-反应蛋白(CRP)于起病后12~24 h才呈现异常升高。共分离细菌36株,主要有凝固酶阴性葡萄球菌14株(CNS,38.89%)、肺炎克雷伯菌12株(33.33%)、阴沟肠杆菌3株(8.33%)、肠球菌2株(5.56%);100%CNS为耐甲氧西林菌株(MRCNS),66.7%肺炎克雷伯菌为产超广谱β-内酰胺酶(ESBLs)菌株。药敏显示MRCNS和ESBLs均多重耐药,但分别对万古霉素和亚胺培南全部敏感。结论:CNS和肺炎克雷伯菌,特别是MRCNS和ESBLs是NICU败血症的两大主要致病菌,其临床症状呈多样化和非特异性,动态血象和CRP变化可协助早期诊断;减少侵入性操作、严格消毒隔离制度、重视医护人员手卫生、严格掌握三代头孢菌素和预防性抗生素的应用指征可减少MRCNS和ESBLs菌株的感染机会;万古霉素、亚胺培南可分别作为MRCNS和ESBLs败血症的首选抗生素。
Objective: To investigate the clinical features, pathogens distribution and drug sensitivity of NICU neonatal sepsis. Methods: The clinical data of 34 neonates with sepsis diagnosed from January 1998 to December 2007 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Results: 34 newborns all had varying degrees of eating less, crying less, less exercising and less weight, fever in 10 cases, shock in 10 cases, jaundice increased or prolonged in 9 cases, apnea in 7 cases, feeding intolerance 6 Cases, combined with local infection in 10 cases. Dynamic hemogram showed WBC <5x109 / L (41.18%) was more common (P <0.05) than WBC> 20x109 / L (8.82%). WBC and platelet count decreased significantly at onset (P <0.05). CRP> 8 mg / L in 17 cases (17/24, 70.83%), CRP≤8 mg / L in 7 cases (7/24, 29.17%). Seven cases (29.17%) of C-reactive protein (CRP) showed an abnormal increase 12 to 24 hours after onset. Thirty-six strains of bacteria were isolated, including 14 strains of coagulase-negative staphylococci (CNS, 38.89%), 12 strains of Klebsiella pneumoniae (33.33%), 3 strains of Enterobacter cloacae (8.33% %); 100% CNS was methicillin-resistant (MRCNS) and 66.7% Klebsiella pneumoniae were ESBLs-producing strains. Drug susceptibility showed that both MRCNS and ESBLs were multi-drug resistant, but all were sensitive to vancomycin and imipenem. Conclusions: Both CNS and Klebsiella pneumoniae, especially MRCNS and ESBLs, are the two main pathogens of NICU sepsis. The clinical symptoms are diversified and nonspecific. The changes of dynamic blood and CRP may be helpful for the early diagnosis and reduce invasive procedures , Strict disinfection and isolation system, emphasis on health care workers hand hygiene, strict control of third-generation cephalosporins and prophylactic antibiotics indications can reduce the MRCNS and ESBLs strains of infection opportunities; vancomycin, imipenem MRCNS and ESBLs The preferred antibiotic for sepsis.