极低/超低出生体重儿细菌性与真菌性晚发型败血症临床分析

摘要
图/表
参考文献(18)
相关文章 (11)

全文: PDF (0 KB) HTML (41 KB)
输出: BibTeX | EndNote (RIS)

摘要

目的分析比较极低/超低出生体重儿细菌性与真菌性晚发型败血症（LOS）的临床特征、病原菌及预后。方法收集安徽医科大学第一附属医院2015年7月—2020年6月收治的血培养阳性的62 例极低/超低出生体重败血症患儿的临床资料进行回顾性分析，根据血培养结果将其分为细菌组（37 例）和真菌组（25 例），统计两组极低/超低出生体重儿LOS 的发生率、病死率、病原菌，分析比较两组发病时的临床表现及预后。结果研究期间共有1115 例极低/超低出生体重儿，血培养阳性败血症发生率为5.56%。细菌组最常见病原菌为肺炎克雷伯菌（12 株，19.35%），真菌组最常见病原菌为光滑假丝酵母（11 株，17.74%）。真菌组呼吸暂停、腹胀/呕吐/潴留、脾增大多于细菌组，差异有统计学意义（P＜0.05）；细菌组心率增快比例高于真菌组，血小板＜100×109/L 的比例低于真菌组（P＜0.05），C反应蛋白（CRP）、降钙素原（PCT）值高于真菌组，差异均有统计学意义（P＜0.05）；细菌组并发中枢神经系统感染低于真菌组，差异有统计学意义（P＜0.05）。结论极低/超低出生体重儿LOS 发生率高，发病时临床表现不具有特异性，心率增快、CRP 和PCT 升高提示细菌感染，呼吸暂停、腹胀、呕吐、潴留、脾增大、血小板降低多提示真菌感染，真菌感染患儿比细菌感染更易并发中枢神经系统感染。]

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	朱倩倩
	王琍琍

关键词 ：极低出生体重儿, 超低出生体重儿, 晚发型败血症, 临床分析

Abstract：

Objective To analyze and compare the clinical features,pathogens and prognosis of bacterial and fungal late-onset sepsis(LOS)in very low/extremely low birth weight infants.Methods The clinical data of 62 infants with very low/extremely low birth weight sepsis who were admitted to the First Affiliated Hospital of Anhui Medical University from July 2015 to June 2020 were collected and retrospectively analyzed.According to the results of blood culture,they were divided into a bacterial group(n=37)and a fungal group(n=25).The incidence,mortality,and pathogenic bacteria of LOS of the two groups were counted,and the clinical manifestations and prognosis of the two groups were analyzed and compared.Results There were 1115 very low/extremely low birth weight infants during the study period,and the incidence of positive blood culture sepsis was 5.56%.The most common pathogen in the bacterial group was Klebsiella pneumonia(12 strains,19.35%),and the most common pathogen in the fungal group was Candida glabrata(11 strains,17.74%).In the fungal group,the incidence of apnea,abdominal distension/vomiting/retention,and splenauxe was higher than that in the bacterial group,and the difference was statistically significant(P<0.05).The incidence of increased heart rate in the bacterial group was higher than that of the fungal group,and the ratio of platelets <100×109/L was lower than that in the fungal group,and the differences were statistically significant(P<0.05).The values of C-reactive protein(CRP)and procalcitonin(PCT)were higher than those in the fungal group,and the differences were statistically significant(P<0.05).The complication of central nervous system infection in the bacterial group was lower than that in the fungal group,and the difference was statistically significant(P<0.05).Conclusion The incidence of LOS in very low/extremely low birth weight infants is high.The clinical manifestations at onset are not specific.Increased heart rate,elevated CRP and PCT indicate bacterial infection.Apnea,abdominal distension,vomiting,retention,splenauxe,and decreased platelet are more indicative of fungal infection.Children with fungal infection are more likely to develop central nervous system infection than those with bacterial infection.

Key words： Very low birth weight infant Extremely low birth weight infant Late-onset sepsis Clinical analysis

通讯作者: 王琍琍（1963-），女，硕士，主任医师，研究方向：新生儿疾病

作者简介: 朱倩倩（1994-），女，安徽阜阳人，安徽医科大学第一临床医学院（第一附属医院）2018 级儿科学专业在读硕士研究生，研究方向：新生儿疾病

引用本文:

朱倩倩；王琍琍. 极低/超低出生体重儿细菌性与真菌性晚发型败血症临床分析[J]. 中国当代医药, 2021, 28(24): 162-166.
ZHU Qian-qian； WANG Li-li. Clinical analysis of bacterial and fungal late-onset sepsis in very low/extremely low birth weight infants. 中国当代医药, 2021, 28(24): 162-166.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I24/162

[1]	中华医学会儿科学分会新生儿学组，余加林，吴仕孝.新生儿败血症诊疗方案[J].中华儿科杂志，2003，41（12）：19-21.
[2]	Volante E，Moretti S，Pisani F，et al.Early diagnosis of bacterial infection in the neonate[J].J Matern Fetal Neonatal Med，2004，16 Suppl 2：13-16.
[3]	Giannoni E，Agyeman PKA，Stocker M，et al.Neonatal sepsis of early onset，and Hospital-acquired and community-acquired late onset：a prospective population-based cohort study[J].J Pediatr，2018，201：106-114.
[4]	Stoll BJ，Hansen N，Fanaroff AA，et al.Late-onset sepsis in very low birth weight neonates：the experience of the NICHD Neonatal Research Network[J].Pediatrics，2002，110（2 Pt 1）：285-291.
[10]	陈燕，王杨，赵倩，等.小于胎龄极低出生体质量儿晚发型败血症危险因素分析[J].安徽医学，2016，37（1）：22-26.
[12]	赵倩，陈燕，王杨，等.新生儿细菌和真菌败血症的临床特征和住院费用比较[J].中国当代儿科杂志，2016，18（4）：311-315.
[14]	赵小朋，周伟，李旭芳，等.极低/超低出生体重儿晚发型败血症发生情况及其危险因素分析[J].中国当代儿科杂志，2017，19（11）：1129-1133.
[15]	林丽丹，刘郴州，郭青云，等.早产极低/超低出生体重儿真菌性败血症的特点分析[J].广东医学，2013，34（18）：2836-2837.
[5]	Escalante MJ，Ceriani-Cernadas JM，D′Apremont I，et al.Late onset sepsis in very low birth weight infants in the South American NEOCOSUR Network[J].Pediatr Infect Dis J，2018，37（10）：1022-1027.
[6]	Wójkowska-Mach J，Borszewska-Kornacka M，Domańska J，et al.Early-onset infections of very-low-birth-weight infants in Polish neonatal intensive care units[J].Pediatr Infect Dis J，2012，31（7）：691-695.
[7]	Wójkowska-Mach J，Gulczyńska E，Nowiczewski M，et al.Late-onset bloodstream infections of very-low-birth-weight infants：data from the Polish Neonatology Surveillance Network in 2009-2011[J].BMC Infect Dis，2014，14：339.
[8]	Moro M，Pérez-Rodriguez J，Figueras-Aloy J，et al.Predischarge morbidities in extremely and very low-birth-weight infants in Spanish neonatal units[J].Am J Perinatol，2009，26（5）：335-343.
[9]	Salm F，Schwab F，Geffers C，et al.The implementation of an evidence-based bundle for bloodstream infections in neonatal intensive care units in Germany：a controlled intervention study to improve patient safety[J].Infect Control Hosp Epidemiol，2016，37（7）：798-804.
[11]	Roy A，Chaudhuri J，Sarkar D，et al.Role of enteric supplementation of probiotics on late-onset sepsis by Candida species in preterm low birth weight neonates：a randomized，double blind，placebo-controlled trial[J].N Am J Med Sci，2014，6（1）：50-57.
[13]	Stoll BJ，Hansen NI，Adams-Chapman I，et al.Neurodevelopmental and growth impairment among extremely lowbirth-weight infants with neonatal infection[J].JAMA，2004，292（19）：2357-2365.
[16]	Benjamin DK Jr，Stoll BJ，Fanaroff AA，et al.Neonatal candidiasis among extremely low birth weight infants：risk factors，mortality rates，and neurodevelopmental outcomes at 18 to 22 months[J].Pediatrics，2006，117（1）：84-92.
[17]	Worth LJ，Daley AJ，Spelman T，et al.Central and peripheral line -associated bloodstream infections in Australian neonatal and paediatric intensive care units：findings from a comprehensive Victorian surveillance network，2008 -2016[J].J Hosp Infect，2018，99（1）：55-61.
[18]	Walker WA.The importance of appropriate initial bacterial colonization of the intestine in newborn，child，and adult health[J].Pediatr Res，2017，82（3）：387-395.