摘要
目的探讨极低出生体重儿(very low birth weight infant,VLBWI)晚发型败血症(late-onset sepsis,LOS)的临床特点、致病菌特征及危险因素。方法本研究为回顾性病例对照研究。纳入福建省妇幼保健院新生儿科2010年1月1日至2015年12月31日收治的VLBWI中诊断LOS的病例107例作为病例组,采用1∶1比例选择同期住院非感染VLBWI作为对照组。采用两独立样本t检验、χ2检验、秩和检验和方差分析比较组间患儿的临床特点,采用多因素logistic回归分析LOS的危险因素。结果研究期间VLBWI的LOS发生率为8.6%(107/1239)。107例LOS新生儿中治愈87例,治愈率为81.3%。LOS临床表现多样,常见精神反应差(83例,77.6%)、腹胀(77例,72.0%)和呼吸困难(76例,71.0%);最常见的实验室指标异常是C-反应蛋白升高(76.6%,82/107)。血培养阳性共45例(42.1%,45/107),致病菌以革兰阴性菌最多见(71.1%,32/45),主要是肺炎克雷伯菌。多因素logistic回归分析表明机械通气(OR=21.181,95%CI:1.542~290.948,P=0.022)、喂养不耐受(OR=12.480,95%CI:2.602~59.856,P=0.002)、出现LOS临床表现前联用抗生素(OR=22.457,95%CI:3.933~128.237,P<0.001)、出现LOS临床表现前抗生素使用时间(OR=1.388,95%CI:1.158~1.663,P<0.001)是VLBWI发生LOS的独立危险因素。结论VLBWI的LOS临床表现多样,实验室检查以C-反应蛋白升高最常见,致病菌主要是革兰阴性菌。机械通气、喂养不耐受、出现LOS临床表现前联用抗生素和抗生素使用时间长的VLBWI更容易发生LOS。
Objective To investigate the clinical characteristics, pathogen distribution and risk factors of late-onset sepsis (LOS) in very low birth weight infants (VLBWI).Methods In this retrospective case-control study, 107 VLBWIs diagnosed with LOS and hospitalized in Fujian Provincial Maternity and Children's Hospital from January 1, 2010 to December 31, 2015 were enrolled as LOS group. Another 107 VLBWIs without infection were assigned as control group with an allocation ratio of 1 to 1. The clinical data between groups were compared using two-independent sample t-test, Chi-square test, sum-rank test and univariate analysis of variance, and multivariate logistic regression was used to analyze the risk factors of LOS.Results The incidence of LOS in VLBWI was 8.6% (107/1 239). Among the 107 cases with LOS, 87 recovered with a cure rate of 81.3%. Various clinical presentations were observed, and the most common included lethargy (83/107, 77.6%), abdominal distention (77/107, 72.0%) and dyspnea (76/107, 71.0%). Increased C-reactive protein (CRP) level was the most common laboratory markers (82/107, 76.6%). The blood cultures were positive in 45 (42.1%) cases and the dominant pathogen was Gram-negative bacteria (32/45, 71.1%), especially Klebsiella. The logistic regression analysis showed that mechanical ventilation (OR=21.181, 95%CI: 1.542-290.948, P=0.022), feeding intolerance (OR=12.480, 95%CI: 2.602-59.856, P=0.002), combined application of antibiotics before LOS occurs (OR=22.457, 95%CI: 3.933-128.237, P<0.001), duration of antibiotic treatment before LOS occurs (OR=1.388, 95%CI: 1.158-1.663, P<0.001) were the independent risk factors of LOS for VLBWI.Conclusions The clinical presentation of LOS in VLBWI are diverse and non-specific. Increased CRP level is a sensitive laboratory marker. The main pathogen is Gram-negative bacteria. LOS are more prone to occur in VLBWI with mechanical ventilation, feeding intolerance, combined application of antibiotics or long duration of antibiotic treatment.
作者
修文龙
杨长仪
赖淑华
张宝泉
Xiu Wenlong;Yang Changyi;Lai Shuhua;Zhang Baoquan(Department of Neonatology,Fujian Provincial Maternity and Children's Hospital,Affiliated Hospital of Fujian Medical University,Fuzhou 350001,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2020年第5期338-344,共7页
Chinese Journal of Perinatal Medicine
基金
福建省科技厅引导性项目(2018Y0006)。
作者简介
通信作者:张宝泉,Email:fjfzzbq@163.com。
