早产儿败血症的病原体及其临床特征

Pathogens and clinical features of preterm infants with sepsis

摘要:

目的 分析早产儿败血症的病原体构成及其临床特征，为早期识别和治疗早产儿败血症提供依据。方法 收集2014年1月至2018年5月血培养阳性的371例早产儿败血症患儿的临床资料，根据发病时间分为早发型组（发病日龄 < 7 d，n=73）和晚发型组（发病日龄≥ 7 d，n=298），比较两组在病原体构成、临床特征（首发症状、起病时辅助检查、合并症、预后等）方面的差异。结果 肺炎克雷伯杆菌感染在晚发型组中占比更高（P < 0.05），大肠埃希菌、无乳链球菌和李斯特菌感染在早发型组中占比更高（P < 0.05）。早发型组首发临床表现中呼吸困难比例高于晚发型组（P < 0.05）。早发型组血培养转阴时间、感染前抗生素使用时间及深静脉置管留置时间均短于晚发型组（P < 0.05），晚发型组新生儿坏死性小肠结肠炎的发生率高于早发型组（P < 0.05）。早发型组放弃率高于晚发型组（P < 0.05）。结论 早产儿败血症起病时临床表现及辅助检查不典型，早发型与晚发型早产儿败血症在病原体构成及临床特征方面存在一定差异，应结合发病日龄、临床特征推断可能病原体，及早合理用药。

Abstract:

Objective To investigate the pathogen composition and clinical features of preterm infants with sepsis, and to provide a basis for early identification and treatment of sepsis in preterm infants. Methods A retrospective analysis was performed for the clinical data of 371 preterm infants with sepsis who had a positive blood culture between January 2014 and May 2018. According to the time of onset, the preterm infants were divided into an early-onset group (an age of onset of < 7 days) with 73 preterm infants and a late-onset group (an age of onset of ≥ 7 days) with 298 preterm infants. The two groups were compared in terms of pathogen composition and clinical features (initial symptoms, laboratory examination results at the time of onset, comorbidities, and prognosis). Results There was a higher proportion of infants with Klebsiella pneumoniae infection in the late-onset group (P < 0.05), while there was a higher proportion of infants with Escherichia coli, Streptococcus agalactiae or Listeria infection in the early-onset group (P < 0.05). The early-onset group had a significantly higher proportion of infants with dyspnea than the late-onset group (P < 0.05). Compared with the late-onset group, the early-onset group had significantly shorter time to negative conversion of blood culture, duration of antibiotic use before infection, and indwelling time of deep venous catheterization (P < 0.05), and the late-onset group had a significantly higher incidence rate of neonatal necrotizing enterocolitis than the early-onset group (P < 0.05). The early-onset group had a significantly higher rate of treatment withdrawal than the late-onset group (P < 0.05). Conclusions Preterm infants with sepsis lack typical clinical manifestations and laboratory examination results at the time of onset. There are certain differences in pathogen composition and clinical features between preterm infants with early-and late-onset sepsis. Possible pathogens for sepsis should be considered based on age in days at the time of onset and related clinical features.