作　　者： (朱巍巍）; (李在玲）; (韩彤妍）; (童笑梅）; (朴梅花）;

机构地区： 100191,北京大学第三医院儿科

出　　处： 《中国新生儿科杂志》

摘　　要： 目的 分析早产儿产气肠杆菌感染的易感因素、临床特点、药敏结果及转归情况.方法 回顾性分析本院2014年7 ～10月新生儿重症监护病房收治的住院期间诊断为产气肠杆菌感染的早产儿临床资料,同期按照1∶2比例选取相近胎龄、体重未感染的早产儿资料.比较两组早产儿的基本情况、抗生素应用情况、大便排出情况、有创操作及肠外营养应用时间,以及对产气肠杆菌感染患儿的临床特点、药敏结果及转归情况进行分析.结果 研究期间共诊断产气肠杆菌感染早产儿8例,纳入感染组,其中男3例,女5例,出生体重780 ～2 760 g,胎龄28 ～33周;未感染早产儿16例,纳入对照组,出生体重1070～1 780g,胎龄29 ～ 33周.感染组早产儿产前发生感染的比例高于对照组(3/8比4/16),有创和无创呼吸机通气时间长于对照组[1(0,6)d比0(0,0)d、11(6,36)d比4(0,6)d],差异有统计学意义(P＜0.05).产气肠杆菌感染早产儿临床均有肺炎表现,其中3例患儿发展为败血症(1例为超低出生体重儿,2例为极低出生体重儿);1例因感染中毒性休克死亡.药敏结果显示,病原菌对三代头孢类抗生素均耐药,对美罗培南、哌拉西林钠他唑巴坦钠均敏感,亚胺培南耐药率第1个月1/6,第2个月2/6,第3个月升至9/11,第4个月降至2/4.结论 产前避免感染,缩短呼吸机应用时间可减少产气肠杆菌感染的发生,多数早产儿感染后临床转归好.产气肠杆菌对头孢类抗生素耐药率极高,后期对最初敏感的抗生素产生耐药较快. Objective To study the risk factors,clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection in NICU.Method Preterm infants diagnosed to have infection of aerogenes in our NICU during July 2014 to October 2014 were selected as the infection group in our study.Uninfected preterm infants whose gestational age and birth weight were similar to the infants in infection group were selected as the control group.The ratio of number of infants in infection group and control group was 1 ∶ 2.The basic situation,clinical application of antibiotics before infection,defecation times,invasive manipulations,and parenteral nutrition time of the two groups were retrospectively collected.The clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection were analyzed.Result There were 8 infants in infection group (male:female =3∶5).The birth weight ranged from 780 to 2 760 g;and gestational age from 28 to 33 w.There were 16 infants in the control group (male:female =1 ∶ 1).The birth weight ranged from 1 070 to 1 780 g,and gestational age,from 29 to 33 w.The incidence of prenatal infection in infection group was higher than that in the control group (3/8 vs.4/16,P ＜ 0.05).Comparing the two study groups,there were statistical differences between them in the following aspects (all P ＜ 0.05):non-invasive respiratory support time [11 (6,36) d vs.4 (0,6) d] and invasive mechanical ventilation time [(1 (0,6) d vs.0 (0,0) d].All the 8 infants in infection group had pneumonia,3 of them with sepsis (1 case was extremely low birth weight infant,and 2 cases were very low birth weight infants),and one of them died from septic shock.Drug sensitivity analysis showed that aerogenes were resistant to all the third generation cephalosporins,and were sensitive to Meropenem and Piperacillin/Tazobactam.The resistance rates of Imipenem were 1/6 in the first month,2/6 in the second month,9/11 in the third month,and 2/4 in the fourth month,respectively.Conclusion Avoidance of prenatal infection and shortening of the application of ventilator may reduce the incidence of aerogenes infection.Most of infants with aerogenes infection have favourable prognosis.The resistance rate of third generation cephalosporins is very high.Aerogenes could develop resistance quickly to the antibiotics which is sensitive initially.

分 类 号： [Z1]