摘要
目的探讨妊娠期感染产单核细胞李斯特菌(LM)的临床特点、诊疗分析及其新生儿预后。方法回顾性分析西安高新医院2013年9月至2017年9月诊治的妊娠期感染LM患者的临床特点、实验室检查、临床治疗和预后情况。结果共收治8例感染LM的孕妇,临床症状均不典型,2例诉腹痛,5例有上呼吸道感染症状,8例体温均有不同程度的升高,均引起胎儿宫内窘迫。实验室检查:白细胞总数、中性粒细胞百分比和C反应蛋白均有不同程度的升高;6例血培养和1例白带培养均检测到LM,1例通过脐血培养出LM。药敏结果显示,LM对青霉素、氨苄西林和复方新诺明敏感性均为100%,8例孕妇根据药敏结果及时调整用药,经治疗预后良好。8例产妇对应新生儿均为早发型感染,经血行感染5例、新生儿肺炎3例、化脓性脑膜炎2例、弥漫性血管内凝血(DIC)1例;患儿白细胞总数大部分正常,血小板部分降低,C反应蛋白和降钙素均升高,虽然确诊患儿也给予目标性治疗,但最终仅1例治愈。结论妊娠期感染LM的临床特点虽不典型,但对不明原因发热的孕妇,应及时送检血培养,并选择青霉素类药物进行经验性治疗,以降低新生儿感染率和死亡率。
Objective To explore the clinical features,diagnosis and treatment of listeria monocytogenes(LM)in pregnancy infection and neonatal prognosis.Methods Retrospectively analysis was conducted on the clinical features,laboratory examination and clinical treatment of pregnant women infected with LM as well as neonatal prognosis during the period of September 2013 to September2017 in Xi’an Gaoxin Hospital.Results A total of 8 pregnant women infected with LM were diagnosed with atypical clinical symptoms,including 2 with abdominal pain and 5 with symptoms of upper respiratory tract infection.Eight cases were featured with different degrees of increase in body temperature,and caused fetal distress.The total number of white blood cells,the percentage of neutrophils and the c-reactive protein were all increased in laboratory examination.LM was detected in blood culture of 6 cases,leucorrhea culture of 1 case,and umbilicus blood culture of 1 case.The results of drug sensitivity showed that LM was100%sensitive to penicillin,ampicillin and compound sinolamine,and the prognosis of 8 pregnant women was good after targeted treatment.Neonates of all these 8 cases were associated with early-onset infection.There were 5 cases of infection through blood,3 cases of neonatal pneumonia,2 cases of purulent meningitis and 1 case of DIC.Most of the neonates had normal white blood cells,decreased platelets,and increased c-reactive protein and calcitonin.Although targeted treatment was given to the confirmed neonates,only one was cured.Conclusion Although the clinical characteristics of LM infection during pregnancy are not typical,for pregnant women with fever of unknown reasons,blood culture should be timely done for examination,and penicillin drugs should be selected for treatment,so as to reduce the infection rate and mortality rate of their newborns.
作者
武爱荣
李维玲
WU Ai-rong;LI Wei-ling(Department of Clinical Laboratories,Xi'an Gaoxin Hospital,Shaanxi Xi'an 710075,China;Department of Obstetrics,Xi 'an Gaoxin Hospital,Shaanxi Xi'an 710075,China)
出处
《中国妇幼健康研究》
2018年第12期1599-1603,共5页
Chinese Journal of Woman and Child Health Research
关键词
产单核细胞李斯特菌
孕妇
新生儿
感染
预防
listeria monocytogenes (LM)
pregnant women
newborn
infection
prevention
