摘要
目的分析新生儿败血症病原菌构成及耐药性,检测降钙素原及中性粒细胞CD64水平的变化,并探讨其临床意义。方法收集无锡市儿童医院2014年1月-2017年1月新生儿病房收治的新生儿败血症60例为败血症组,入院后立即进行血培养;同期入院的新生儿颅内出血、新生儿缺氧缺血性脑病等42例为非感染组;同期出生健康新生儿30例为健康对照组。对败血症组血培养结果进行病原菌构成及耐药性分析,并检测3组新生儿的血降钙素原及血液中性粒细胞CD64水平。结果败血症组60例新生儿中18例血培养呈阳性,阳性率为30.0%。分离出病原菌65株,其中革兰阳性菌47株(72.31%),以表皮葡萄球菌(32株)和金黄色葡萄球菌(10株)为主;革兰阴性菌16株(24.62%),以大肠埃希菌(8株)和肺炎克雷伯菌(4株)为主;真菌2株(3.08%)。革兰阳性球菌对青霉素耐药率为96.9%,对氨苄西林、红霉素、复方磺胺甲噁唑耐药率在60.0%~100.0%之间。革兰阴性杆菌对氨苄西林耐药率为100.0%,对头孢曲松、复方磺胺甲噁唑和头孢呋辛的耐药率在62.5%~100.0%之间,对头孢吡肟、阿米卡星、头孢哌酮耐药率较低。治疗前,败血症组降钙素原和CD64水平均显著高于健康对照组(P<0.05);非细菌感染组降钙素原和血液中性粒细胞CD64水平与健康对照组相比差异无统计学意义(P>0.05)。治疗后,败血症组降钙素原与血液中性粒细胞CD64水平下降,但CD64水平仍显著高于健康对照组(P<0.05)。结论引起新生儿败血症的病原菌以表皮葡萄球菌,金黄色葡萄球菌,大肠埃希菌和肺炎克雷伯菌较常见,且对常用抗菌药物有一定抗性,治疗时应根据血培养和药敏试验结果合理选用抗菌药物。败血症新生儿血降钙素原与血液中性粒细胞CD64水平升高,且恢复期时CD64仍高于正常水平。如何降低败血症患儿CD64水平有待进一步研究。
Objective To analyze the composition and drug resistance of pathogens causing neonatal septicemia and changes in procalcitonin and neutrophil CD64 levels in order to provide a clinical basis for early diagnosis of neonatal septicemia. Methods Sixty patients with neonatal septicemia were treated in the neonatal ward of Wuxi Children＇s Hospital from January 2014 to January 2017.These patients served as patients with septicemia,and a blood culture was performed immediately after admission.Forty-two newborns with an intracranial hemorrhage,hypoxic-ischemic encephalopathy,or some other disease who were hospitalized during the same period served as uninfected patients.Thirty healthy newborns who were born during the same period served as the healthy control group.The composition and drug resistance of pathogenic bacteria were analyzed in patients with septicemia,and levels of calcitonin and CD64 were analyzed in the three groups. Results Blood cultures from 18 of 60 newborns tested positive for a pathogen at a rate of 30%.Sixty-five strains of pathogens were isolated,including 47 strains（72.31%）of Gram-positive bacteria.Gram-positive bacteria were mainly Staphylococcus epidermidis（32 strains）and Staphylococcus aureus（10 strains）.Sixteen strains（24.62%）of Gram-negative bacteria were isolated.Gram-negative bacteria were mainly Escherichia coli（8 strains）and Klebsiella pneumoniae（4 strains）.Two strains（3.08%）of fungi were isolated.The resistance of Gram-positive cocci to penicillin was 96.9%,and their resistance to ampicillin,erythromycin,and sulfamethoxazole ranged from 60.0-100.0%.The resistance of Gram-negative bacilli to ampicillin was 100%.The resistance of Gram-negative bacilli to ceftriaxone,sulfamethoxazole,and cefuroxime ranged from 62.5-100.0%,and they were sensitive to cefepime,amikacin,and cefoperazone.Before treatment,the levels of procalcitonin and CD64 in patients with septicemia were 24.06±18.22μg/L and60.32±19.45 MFI,and the levels of procalcitonin and CD64 in the healthy control group were 0.32±0.16μg/L and 25.14±5.11 MFI.The levels of calcitonin and CD64 in patients with septicemia were significantly higher than those in the healthy control group（P〈0.05）.The levels of procalcitonin and CD64 in uninfected patients were 0.35±0.19μg/L and26.58±5.03 MFI.Levels did not differ significantly from those in the healthy control group（P〉0.05）.After treatment,the levels of procalcitonin and CD64 in patients with septicemia were 0.40±0.20μg/L and 40.18±17.56 MFI.The levels decreased significantly,but the level of CD64 was 40.18±17.56 MFI,which was significantly higher than that in the healthy control group（P〈0.05）. Conclusion The pathogens causing neonatal sepsis were S.epidermidis,S.aureus,E.coli,and K.pneumoniae.These bacteria were resistant to common antibiotics to an extent,and antibiotics should be selected rationally in accordance with the results of a blood culture and drug sensitivity testing.The levels of procalcitonin and CD64 increased in neonates with septicemia,and the level of CD64 was higher than the normal level during recovery.How to reduce the level of CD64 in newborns with septicemia needs to be studied further.
作者
王昌林
金未来
李雅雯
朱玉婷
李征瀛
WANG Chang-lin;JIN Wei-lai;LI Ya-wen;ZHU Yu-ting;LI Zheng-ying(Neonatology, Wuxi Children＇s Hospital, Wuxi 214023, Jiangsu , China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2018年第5期528-531,共4页
Journal of Pathogen Biology
基金
江苏省医学创新团队项目(No.CXTDB2017016)
