胎膜早破新生儿感染的不同抗生素使用策略及高危因素分析

Effect of different antibiotic use strategies on infection in neonates with premature rupture of membranes and high-risk factors for neonatal infection

摘要:

目的 探讨不同抗生素使用策略对胎膜早破新生儿感染的影响及胎膜早破新生儿感染的影响因素分析。方法 回顾性收集胎膜早破新生儿223例为研究对象，依据抗生素使用策略不同将患儿分为研究组（n=95）和对照组（n=128）。研究组入院后以风险评估与感染筛查结果相结合使用抗生素，对照组入院后以风险评估结果使用抗生素，比较两组患儿一般情况及预后。按是否感染将患儿分为感染组（n=32）及非感染组（n=191），比较两组患儿的一般临床资料，并采用logistic回归分析导致胎膜早破新生儿感染的高危因素。结果 与对照组相比，研究组胎膜早破时间较长，剖宫产率较高，抗生素总使用率及入院时抗生素使用率均较低，感染发生率较高，但败血症发生率较低（P < 0.05），其他并发症发生率在两组间比较差异无统计学意义（P > 0.05）。与非感染组比较，感染组患儿胎龄较小，胎膜早破时间较长，剖宫产率高，入院时及复查的CRP及PCT水平均较高，发热为常见症状（P < 0.05）。早产儿、剖宫产为胎膜早破新生儿发生感染的高危因素（P < 0.05）。结论 对胎膜早破新生儿严格遵循抗生素使用指征不会增加并发症的发生率；胎膜早破新生儿，特别是早产儿及剖宫产儿，应密切观察其病情的变化，如有发热表现，尽早复查CRP等感染指标，及时使用抗生素，防止严重感染。

Abstract:

Objective To study the effect of different antibiotic use strategies on infection in neonates with premature rupture of membranes and the high-risk factors for neonatal infection. Methods A retrospective analysis was performed for the clinical data of 223 neonates with premature rupture of membranes. According to the antibiotic use strategies, they were classified into two groups: study group (n=95) and control group (n=128). The neonates in the study group were given antibiotics based on risk assessment and infection screening, and those in the control group were given antibiotics based on risk assessment alone after admission. General status and prognosis were compared between the two groups. According to the presence or absence of infection, the neonates were classified into two groups: infection group (n=32) and non-infection group (n=191). The clinical data were compared between the two groups. A logistic regression model was used to investigate the high-risk factors for infection in neonates with premature rupture of membranes. Results Compared with the control group, the study group had a significantly longer time of premature rupture of membranes, a significantly higher rate of cesarean section, and a significantly lower antibiotic use rate at admission and a significantly lower total antibiotic use rate (P < 0.05). The study group also had a significantly higher incidence rate of infection and a significantly lower incidence rate of sepsis (P < 0.05). There were no significant differences in the incidence rates of other complications between the two groups (P > 0.05). Compared with the noninfection group, the infection group had a significantly lower gestational age, a significantly longer time of premature rupture of membranes, a significantly higher rate of cesarean section, and significantly higher levels of C-reactive protein (CRP) and procalcitonin on admission and during reexamination (P < 0.05), with fever as the most common symptom. The logistic regression analysis showed that preterm birth and cesarean section were high-risk factors for infection in neonates with premature rupture of membranes (P < 0.05). Conclusions Strict adherence to the indications for antibiotic use in neonates with premature rupture of membranes does not increase the incidence rate of complications. Neonates with premature rupture of membranes, especially preterm infants and infants delivered by cesarean section, should be closely observed for the change in disease conditions, and infection indices including CRP should be reexamined in case of fever and antibiotics should be used to prevent serious infection.