新生儿重症监护室229例新生儿泌尿系感染临床分析

Urinary tract infections in the neonatal intensive care unit: clinical analysis of 229 cases

摘要:

目的：分析新生儿重症监护室（NICU）新生儿泌尿系感染（UTI）的临床特点、病原体分布、病原体药敏及治疗效果。方法：回顾性分析NICU 229例新生儿UTI患儿的临床资料。结果：新生儿UTI临床表现主要为发热或者体温不规则、吃奶少或者拒奶、黄疸不退、呕吐、腹泻、体重不增、精神萎靡等。居于前三位的病原体主要为大肠埃希氏菌、屎肠球菌、肺炎克雷伯杆菌。大肠埃希菌和肺炎克雷伯杆菌对氨苄西林及大部分头孢类药物具有较强的耐药性（≥85%），而对亚胺培南、美罗培南100%敏感，其次对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦也有很高的敏感性（>90%）；屎肠球菌对青霉素（100%）、利福平（84%）、庆大霉素（79%）的耐药率高，对万古霉素最敏感。结论：新生儿UTI临床表现不典型，多以全身症状为主；主要致病菌以大肠埃希菌为主，但屎肠球菌检出率及耐药率均较高，主要致病菌对大部分青霉素及头孢类耐药，临床医生应参考药敏试验结果决定临床用药。

Abstract:

OBJECTIVE: To study the clinical features, distribution of pathogens, drug susceptibility, and treatment effectiveness in neonates with urinary tract infection (UTI) and admitted to the neonatal intensive care unit (NICU). METHODS: The clinical data of 229 neonates who developed UTI during their stay in the NICU were retrospectively studied. RESULTS: The main clinical manifestations of these children included fever/irregular body temperature, refusing to milk feeding, jaundice, vomiting, diarrhea, poor weight gain, and lethargy. The top three pathogens were Escherichia coli, Enterococcus feces, and Klebsiella pneumoniae. Escherichia coli and Klebsiella pneumoniae were highly resistant to ampicillin and most cephalosporins (≥85%), and were highly sensitive to imipenem (100%), meropenem (100%), cefoperazone/sulbactam and piperacillin/tazobactam (>90%). Enterococcus feces were highly resistant to penicillin (100%), rifampicin (84%). and gentamicin (79%), but were sensitive to vancomycin. CONCLUSIONS: The clinical manifestations of neonatal UTI are often atypical and manifested as systemic symptoms. The main pathogenic bacterium is Escherichia coli, and the isolation rate of enterococci can also be high. Most pathogenic bacteria are resistant to penicillin and cephalosporins, and therefore decision-making on drug administration must be based on the results of drug sensitivity tests.