新生儿细菌和真菌败血症的临床特征和住院费用比较

Clinical features and hospital costs of neonatal sepsis caused by bacteria and fungi: a comparative analysis

摘要:

目的 分析比较革兰阳性菌(G⁺)、革兰阴性菌(G^-)和真菌所致新生儿败血症的临床特征和住院费用.方法 对236 例新生儿败血症患儿的临床资料进行回顾性分析,包括G⁺ 菌败血症110 例,G^-菌败血症68 例,真菌败血症58 例.结果 G⁺ 菌组足月儿占62%,G^-菌组足月儿占38%,真菌组早产儿占86%,真菌组新生儿的胎龄、出生体重小于G⁺ 菌组和G^-菌组(P<0.05).G^-菌组、真菌组中多胎所占比例高于G⁺ 菌组(P<0.0125).G^-菌组胎膜早破>18 h、羊水Ⅲ度污染、早发型败血症的比例均高于G⁺ 菌组和真菌组(P<0.0125).G⁺ 菌组起病症状为体温异常、脐炎或疱疹的患儿比例高于G^-菌组和真菌组(P<0.0125).真菌组呼吸暂停的发生率高于G⁺ 菌组和G^-菌组(P<0.0125).真菌组血小板降低的发生率高于G⁺ 菌组和G^-菌组(P<0.0125).真菌组住院时间长于G⁺ 菌组和G^-菌组(P<0.05),住院总费用高于G⁺ 菌组和G^-菌组(P<0.05).结论 G⁺菌败血症以足月儿为主;G^-菌败血症多见于早发型;真菌败血症多见于早产儿和低出生体重儿,易发生呼吸暂停、血小板减少,且住院时间和住院费用高于细菌败血症.

Abstract:

Objective To study the clinical features and hospital costs of neonatal sepsis caused by Gram-positive (G⁺) bacteria, Gram-negative (G^-) bacteria, and fungi. Methods The clinical data of 236 neonates with sepsis were analyzed retrospectively. Among these neonates, 110 had sepsis caused by G⁺ bacteria, 68 had sepsis caused by G^- bacteria, and 58 had sepsis caused by fungi. Results Full-term infants accounted for 62% and 38%, respectively, in the G⁺ bacteria and G^- bacteria groups, and preterm infants accounted for 86% in the fungi group. The neonates in the fungi group had significantly lower gestational ages and birth weights than those in the G⁺ and G^- bacteria groups (P<0.05). Compared with the G⁺ bacteria group, the G^- bacteria and fungi groups had significantly higher rates of multiple births (P<0.0125). Compared with the G⁺ bacteria and fungi groups, the rates of premature rupture of membranes >18 hours, grade III amniotic fluid contamination, and early-onset sepsis in the G^- bacteria group were significantly higher (P<0.0125). Compared with the G^- bacteria and fungi groups, the G⁺ bacteria group showed significantly higher rates of abnormal body temperature, omphalitis or herpes as the symptom suggesting the onset of such disease (P<0.0125). The fungi group had significantly higher incidence rates of apnea and low platelet count than the G⁺ and G^- bacteria groups (P<0.0125). The comparison of length of hospital stay and total hospital costs between any two groups showed that the fungi group had a significantly longer hospital stay and significantly higher total hospital costs than the G⁺ and G^- bacteria groups (P<0.05). Conclusions Sepsis caused by G⁺ bacteria mainly occurs in full-term infants, and most cases of sepsis caused by G^- bacteria belong to the early-onset type. Sepsis caused by fungi is more common in preterm infants and low birth weight infants, and has high incidence rates of apnea and low platelet count, as well as a longer hospital stay and higher hospital costs than sepsis caused by bacteria.