极早产儿医院感染的病原学特点及并发症分析
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摘要
目的分析极早产儿医院感染的病原菌分布与耐药性及并发症发生情况,为医院感染的预防和控制提供研究依据。方法选取2016年12月-2018年2月医院收治的139例极早产儿作为研究对象,观察患儿医院感染发生情况,采集感染相关样本进行病原菌培养与鉴定,并进行耐药性分析。对感染患儿和未感染患儿的早产儿视网膜病变(ROP)、支气管肺发育不良(BPD)、脑室周围白质软化(PVL)、脑室内出血(IVH)发生率进行观察和比较。结果 139例极早产儿共54例患儿发生医院感染,感染率为38.85%,以呼吸系统感染和血流感染为主,构成比分别为52.78%和38.89%。39例患儿临床样本检出病原菌,检出率为72.22%(39/54),共检出60株病原菌,革兰阴性菌33株占55.00%,真菌25株占41.67%,革兰阳性菌2株占3.33%;铜绿假单胞菌、白假丝酵母、光滑假丝酵母为主要病原菌。主要革兰阴性菌对青霉素类、头孢菌素类抗菌药物的耐药性均较高,对妥布霉素、庆大霉素等氨基糖苷类抗菌药物和诺氟沙星、左氧氟沙星等喹诺酮类抗菌药物的耐药率较低,对亚胺培南、美罗培南等碳青霉烯类抗菌药物的耐药率均在30%～60%。真菌对伊曲康唑、氟康唑、伏立康唑的耐药率较高,未检出对5-氟胞嘧啶或两性霉素B耐药的菌株。发生医院感染患儿的ROP、BPD、PVL发生率高于未发生感染患儿(P<0.05)。结论极早产儿医院感染的病原菌以革兰阴性菌和真菌为主,病原菌的耐药性普遍较高,发生感染患儿的神经系统和呼吸系统并发症发生率较高,临床医师应采取有效的预防和控制措施,以改善极早产儿的预后。
OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infection in the very preterm infants and analyze the prevalence of complications so as to provide guidance for prevention and control of the nosocomial infection.METHODS A total of 139 very preterm infants who were treated in the hospital from Dec 2016 to Feb 2018 were enrolled in the study,the prevalence of nosocomial infection in the infants was observed,the related specimens of the infants were collected for culture,the isolated pathogens were identified,and the drug resistance was analyzed.The incidence rates of retinopathy of prematurity(ROP),bronchopulmonary dysplasia(BPD),periventricular leukomalacia(PVL)and intraventricular hemorrhage(IVH)were observed and compared between the infants with infection and the infants without infection.RESULTS Of the 139 very preterm infants,54 had nosocomial infection,with the infection rate 38.85%,52.78% of whom had respiratory system infection,and 38.89% had bloodstream infection.The pathogens were found in the clinical specimens of 39 infants,with the isolation rate 72.22%(39/54);totally 60 strains of pathogens were isolated,33(55.00%)of which were gram-negative bacteria,25(41.67%)were fungi,and 2(3.33%)were gram-positive bacteria.Pseudomonas aeruginosa,Candida albicans and Candida glabrata were the predominant species of pathogens.The major species of the gram-negative bacteria were highly resistant to penicillin and cephalosporins,the drug resistance rates to aminoglycosides such as tobramycin and gentamicin as well as quinolones such as norfloxacin and levofloxacin were low,and the drug resistance rates to carbapenems like imipenem and meropenem ranged between 30% and 60%.The drug resistance rates of the fungi to itraconazole,fluconazole and voriconazole were high,however,the strains that were resistant to 5-fluorocytosine or amphotericin B were not detected.The incidence rate of ROP,BPD and PVL of the infants with nosocomial infection were significantly higher than those of the infants without the infection(P<0.05).CONCLUSIONThe gram-negative bacteria and fungi are dominant among the pathogens causing the nosocomial infection in the very preterm infants,the drug resistance rates of the pathogens are generally high,the incidence rates of nervous system and respiratory system complications are highI.tisnecessary for clinicians to take effective prevention measures so as to improve the prognosis of the very preterm infants.
OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infection in the very preterm infants and analyze the prevalence of complications so as to provide guidance for prevention and control of the nosocomial infection.METHODS A total of 139 very preterm infants who were treated in the hospital from Dec 2016 to Feb 2018 were enrolled in the study,the prevalence of nosocomial infection in the infants was observed,the related specimens of the infants were collected for culture,the isolated pathogens were identified,and the drug resistance was analyzed.The incidence rates of retinopathy of prematurity(ROP),bronchopulmonary dysplasia(BPD),periventricular leukomalacia(PVL)and intraventricular hemorrhage(IVH)were observed and compared between the infants with infection and the infants without infection.RESULTS Of the 139 very preterm infants,54 had nosocomial infection,with the infection rate 38.85%,52.78% of whom had respiratory system infection,and 38.89% had bloodstream infection.The pathogens were found in the clinical specimens of 39 infants,with the isolation rate 72.22%(39/54);totally 60 strains of pathogens were isolated,33(55.00%)of which were gram-negative bacteria,25(41.67%)were fungi,and 2(3.33%)were gram-positive bacteria.Pseudomonas aeruginosa,Candida albicans and Candida glabrata were the predominant species of pathogens.The major species of the gram-negative bacteria were highly resistant to penicillin and cephalosporins,the drug resistance rates to aminoglycosides such as tobramycin and gentamicin as well as quinolones such as norfloxacin and levofloxacin were low,and the drug resistance rates to carbapenems like imipenem and meropenem ranged between 30% and 60%.The drug resistance rates of the fungi to itraconazole,fluconazole and voriconazole were high,however,the strains that were resistant to 5-fluorocytosine or amphotericin B were not detected.The incidence rate of ROP,BPD and PVL of the infants with nosocomial infection were significantly higher than those of the infants without the infection(P<0.05).CONCLUSIONThe gram-negative bacteria and fungi are dominant among the pathogens causing the nosocomial infection in the very preterm infants,the drug resistance rates of the pathogens are generally high,the incidence rates of nervous system and respiratory system complications are highI.tisnecessary for clinicians to take effective prevention measures so as to improve the prognosis of the very preterm infants.
引文
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[14]谢露露,罗先琼,聂川,等.母婴围生期感染因素对早产儿视网膜病的影响[J].中华实用儿科临床杂志,2017,32(10):759-762.
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[17]Bhandari A,Panitch H.An update on the post-NICU discharge management of bronchopulmonary dysplasia[J].Semin Perinatol,2018,42(7):471-477.
[18]Lal CV,Bhandari V,Ambalavanan N.Genomics,microbiomics,proteomics,and metabolomics in bronchopulmonary dysplasia[J].Semin Perinatol,2018,42(7):425-431.
[19]Wang LW,Lin YC,Wang ST,et al.Identifying risk factors shared by bronchopulmonary dysplasia,severe retinopathy,and cystic periventricular leukomalacia in very preterm infants for targeted intervention[J].Neonatology,2018,114(1):17-24.
[20]Qiao L,Fu J,Xue X,et al.Neuronalinjury and roles of apoptosis and autophagy in a neonatal rat model of hypoxia-ischemia-induced periventricular leukomalacia[J].Mol Med Rep,2018,17(4):5940-5949.
[2]Regenbogen E,Zhang S,Yang J,et al.Epidemiological trends among preterm infants with apnea.A twelve-year database review[J].IntJPediatrOtorhinolaryngol,2018,107:86-92.
[3]Shah PS,McDonald SD,Barrett J,et al.The Canadian Preterm Birth Network:a study protocol for improving outcomes for preterm infants and their families[J].CMAJ Open,2018,6(1):E44-E49.
[4]Jasani B,Rao S,Patole S.Withholding feeds and transfusionassociated necrotizing enterocolitis in preterm infants:a systematic review[J].Adv Nutr,2017,8(5):764-769.
[5]Ali E,Al-Shafouri N,Hussain A,et al.Assessment of WINROPalgorithm as screening tool for preterm infants in Manitoba to detect retinopathy of prematurity[J].Paediatr Child Health,2017,22(4):203-206.
[6]Sharp M,French N,McMichael J,et al.Survival and neurodevelopmental outcomes in extremely preterm infants 22-24weeks of gestation born in Western Australia[J].J Paediatr Child Health,2018,54(2):188-193.
[7]中华医学会儿科学分会新生儿学组.早产儿管理指南[J].中华儿科杂志,2006,57(3):188-191.
[8]中华人民共和国卫生部,中华医院管理学会医院感染管理专业委员会.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[9]International Committee for the Classification of Retinopathy of Prematurity.The international classification of retinopathy of prematurity revisited[J].Arch Ophthalmol,2005,123(7):991-999.
[10]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:416-422,715-723.
[11]张云霞,钱婷婷,张国英.早产儿院内病原菌分布及耐药性与感染危险因素研究[J].检验医学与临床,2017,14(13):1972-1975.
[12]游楚明,陈历耋,谢燕丕,等.早产儿肺炎克雷伯菌感染临床分析[J].中国妇幼健康研究,2017,28(10):1299-1301.
[14]谢露露,罗先琼,聂川,等.母婴围生期感染因素对早产儿视网膜病的影响[J].中华实用儿科临床杂志,2017,32(10):759-762.
[15]Qanitha A,de Mol BA,Pabittei DR,et al.Infections in early life and premature acute coronary syndrome:a case-control study[J].Eur J Prev Cardiol,2016,23(15):1640-1648.
[16]Yang YC,Mao J.Value of platelet count in the early diagnosis of nosocomial invasive fungal infections in premature infants[J].Platelets,2018,29(1):65-70.
[17]Bhandari A,Panitch H.An update on the post-NICU discharge management of bronchopulmonary dysplasia[J].Semin Perinatol,2018,42(7):471-477.
[18]Lal CV,Bhandari V,Ambalavanan N.Genomics,microbiomics,proteomics,and metabolomics in bronchopulmonary dysplasia[J].Semin Perinatol,2018,42(7):425-431.
[19]Wang LW,Lin YC,Wang ST,et al.Identifying risk factors shared by bronchopulmonary dysplasia,severe retinopathy,and cystic periventricular leukomalacia in very preterm infants for targeted intervention[J].Neonatology,2018,114(1):17-24.
[20]Qiao L,Fu J,Xue X,et al.Neuronalinjury and roles of apoptosis and autophagy in a neonatal rat model of hypoxia-ischemia-induced periventricular leukomalacia[J].Mol Med Rep,2018,17(4):5940-5949.