摘要
目的探讨早发型新生儿李斯特菌败血症的临床特点,分析其药敏试验结果。方法回顾性分析2013年6月至2019年8月青岛妇女儿童医院收治的15例早发型新生儿李斯特菌败血症患儿的临床资料,分析其临床特点、药敏试验、治疗方案和预后。结果15例早发型李斯特菌败血症发病年龄均在生后24 h以内。母亲明确产前感染12例(其中发热8例,C-反应蛋白明显增高9例),分娩时伴有Ⅱ~Ⅲ度羊水污染者8例,伴有胎儿宫内窘迫者7例。15例患儿的主要临床表现为发热(13/15)、呼吸困难(12/15)、肌张力异常(10/15)、反应差(10/15)、惊厥(2/15);外周血血常规示白细胞计数增高8例、白细胞数明显降低3例、C-反应蛋白明显升高12例、血小板减少9例、降钙素原升高11例。15例患儿均进行脑脊液检查,10例合并细菌性脑膜炎。从患儿外周血及脑脊液培养中共分离出20株单核细胞增生李斯特菌(其中血标本15例,脑脊液5例),体外药敏试验示患儿对哌拉西林他唑巴坦、左氧氟沙星、复方新诺明、红霉素、美罗培南、万古霉素等敏感率均为100.0%;对氨苄西林、青霉素、苯唑西林敏感率分别为25.0%、30.0%、45.0%。15例患儿分别经哌拉西林他唑巴坦、美罗培南、万古霉素等抗生素抗感染治疗,11例患儿治愈出院,2例好转出院,1例患儿放弃治疗后死亡,1例患儿因脑积水加重转上级医院。结论早发型新生儿李斯特菌败血症病情凶险,合并神经系统感染几率高,对母亲伴有产前感染的高危新生儿应高度警惕,尽早选用有效抗生素治疗。
Objective To investigate the clinical characteristics of 15 neonates with early Listeria sepsis,and analyze the drug sensitivity.Methods Totally 15 cases of early neonatal Listeria sepsis that were treated in the Qingdao Women and Children′s Hospital from June 2013 to August 2019 were enrolled in this study.The clinical characteristics,antimicrobial susceptibility,treatment and prognosis were collected and retrospectively analyzed.Results The age of onset of early Listeria septicemia in all the 15 neonates was within 24 hours after birth.Eight mothers had fever before delivery,9 mothers had C-reactive protein elevated,8 cases showedⅡ~Ⅲgrades of amniotic fluid contamination during delivery,and 7 cases had fetal distress.Clinical manifestations of the 15 neonates included fever(n=13),dyspnea(n=12),abnormal muscle tone(n=10),slow response(n=10)and convulsion(n=2).Blood routine test showed the white blood cells elevated in 8 cases and decreased significantly in 3 cases,C-reactive protein elevated in 12 cases,platelet reduced in 9 cases and procalcitonin elevated in 11 cases.Cerebrospinal fluid(CSF)examination was performed in all the 15 cases,and bacterial meningitis was observed in 10 cases.Totally 20 strains of Listeria monocytogenes(15 from blood and 5 from cerebrospinal fluid)were isolated from the peripheral blood and cerebrospinal fluid of children,and they were all sensitive to piperacillin-tazobactam,levofloxacin,cotrimoxazole,erythromycin,meropenem and vancomycin.The sensitivity rates to ampillin,penicillin and benzacilin were 25.0%,30.0%and 45.0%,respectively.The 15 neonates were treated with piperacillin-tazobactam,meropenem and vancomycin,11 were cured and discharged,2 was improved and discharged,1 died after his giving up the treatment,and 1 was transferred to more advanced hospital because of hydrocephalus.Conclusion Early neonatal Listeria septicaemia is very dangerous,usually combined with nervous system infection,and the high-risk neonates whose mothers had infection before delivery should be p
作者
崔凯洁
邵长荣
孙雪荣
刘秀香
周继勇
CUI Kai-jie;SHAO Chang-rong;SUN Xue-rong;LIU Xiu-xiang;ZHOU Ji-yong(Department of Neonatal Intensive Care Unit,Qingdao Women and Children′s Hospital,Qingdao 266000,China;Department of Pediatrics,Qilu Hospital of Shandong University(Qingdao),Qingdao 266000,China)
出处
《实用药物与临床》
CAS
2021年第6期531-535,共5页
Practical Pharmacy and Clinical Remedies
