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目的分析新生儿重症监护病房新生儿败血症的病原体分布、临床特点、细菌耐药情况及治疗效果。方法回顾性分析新生儿重症监护病房新生儿败血症311例患儿的临床资料。结果早发型败血症患者中,病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、B族溶血性链球菌、屎肠球菌等;晚发型败血症患者中,依次为凝固酶阴性葡萄球菌、肺炎克雷伯菌、大肠杆菌、铜绿假单胞菌、白色念珠菌等。早发型和晚发型败血症中都是凝固酶阴性葡萄球菌败血症发生率最高,且耐药率很高。肺炎克雷伯菌和大肠杆菌中产超广谱β-内酰胺酶高,感染致败血症病情危重。肺炎克雷伯菌是医院感染的主要致病菌,占50%。结论凝固酶阴性葡萄球菌已成为新生儿血培养的首位菌,其耐药性日渐严重。肺炎克雷伯菌是新生儿重症监护病房内医院感染的重要致病菌,它和大肠杆菌败血症的病情均凶险,病死率高。
Objective To analyze the pathogen distribution, clinical features, bacterial resistance and therapeutic effect of neonatal sepsis in neonatal intensive care unit. Methods The clinical data of 311 cases of neonatal sepsis in neonatal intensive care unit were retrospectively analyzed. Results Among the patients with early-onset sepsis, the pathogens were coagulase-negative staphylococci, Escherichia coli, Klebsiella pneumoniae, B hemolytic streptococcus, Enterococcus faecium, etc. Among the patients with late-onset sepsis, the following were coagulase-negative Staphylococcus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Candida albicans and so on. Both early-onset and late-onset sepsis have the highest incidence of coagulase-negative staphylococcal sepsis and high rates of resistance. Klebsiella pneumoniae and Escherichia coli in the production of extended-spectrum β-lactamase high infection-induced sepsis in critical condition. Klebsiella pneumonia is the main pathogen of nosocomial infection, accounting for 50%. Conclusion Coagulase-negative staphylococci have become the first bacteria in neonatal blood culture, and their drug resistance is getting worse day by day. Klebsiella pneumoniae is an important pathogen of nosocomial infection in the neonatal intensive care unit. It is dangerous to E. coli sepsis and has a high case fatality rate.