耳、咽拭子细菌培养对新生儿NICU转运中发生感染的诊断价值
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摘要
目的探究耳、咽拭子细菌培养对新生儿重症监护病房(neonatal intensive care unit,NICU)转运中发生感染的诊断价值。方法将2015年12月至2017年12月本院有高危感染因素的338例新生儿纳入观察组,将本院同期无高危感染因素的100例新生儿纳入对照组。根据是否发生感染将观察组新生儿再分为感染组和未感染组。所有新生儿均于娩出时和娩出后6 h采集耳拭子和咽拭子进行细菌培养,并记录新生儿感染情况。比较观察组和对照组新生儿感染发生情况,以及感染组和未感染组新生儿耳、咽拭子细菌阳性检出率,并对感染组新生儿进行细菌菌群鉴定。结果观察组新生儿感染率显著高于对照组(χ~2=90.396,P <0.001)。感染组新生儿娩出时和娩出后6 h的细菌阳性检出率均显著高于未感染组(P_均<0.001),且感染组新生儿娩出后6 h的细菌阳性检出率显著高于娩出时(P <0.001)。感染组新生儿共检出病原菌396株,其中革兰阴性菌252株,革兰阳性菌141株,真菌3株,革兰阴性菌以大肠埃希菌和鲍曼不动杆菌居多,革兰阳性菌以葡萄球菌为主。结论在进行耳、咽拭子细菌培养时,新生儿娩出后6 h转运至NICU后,细菌阳性检出率更具有价值。
Objective To study the value of bacterial culture of ear and throat swabs in the diagnosis of infection in neonatal intensive care unit(NICU) transport. Method From December 2015 to December 2017, 338 newborns with high risk infection factors were included into observation group, and 100 newborns without high risk infection factors were selected into control group.According to the occurrence of infection, the newborns in observation group were subdivided into infection group and non-infection group. Ear swabs and throat swabs were collected during delivery and 6 hours after delivery for bacterial culture, and neonatal infection was recorded. The incidence of neonatal infection in observation group and control group, as well as the positive rate of bacteria in the ear and throat swabs of infection group and non-infection were compared, and the bacterial ?ora of infection group was identi?ed. Result The neonatal infection rate in observation group was signi?cantly higher than that in control group(χ~2= 90.396,P_(all)< 0.001). The positive rate of bacteria in infection group was signi?cantly higher than that in non-infection at delivery and 6 hours after delivery(P < 0.001), and the positive rate of bacteria in infection group at 6 hours after delivery was signi?cantly higher than that at 6 hours after delivery(P < 0.001). A total of 396 strains of pathogenic bacteria were detected in infection group, including 252 strains of Gram-negative bacteria, 141 strains of Gram-positive bacteria and 3 strains of fungi, Escherichia coli and Acinetobacter baumannii were the most Gram-negative bacteria, and Staphylococcus was the main Gram-positive bacteria. Conclusion During the bacterial culture of ear and throat swabs, the positive rate of bacteria is more valuable when the newborn transported to NICU 6 hours after delivery.
Objective To study the value of bacterial culture of ear and throat swabs in the diagnosis of infection in neonatal intensive care unit(NICU) transport. Method From December 2015 to December 2017, 338 newborns with high risk infection factors were included into observation group, and 100 newborns without high risk infection factors were selected into control group.According to the occurrence of infection, the newborns in observation group were subdivided into infection group and non-infection group. Ear swabs and throat swabs were collected during delivery and 6 hours after delivery for bacterial culture, and neonatal infection was recorded. The incidence of neonatal infection in observation group and control group, as well as the positive rate of bacteria in the ear and throat swabs of infection group and non-infection were compared, and the bacterial ?ora of infection group was identi?ed. Result The neonatal infection rate in observation group was signi?cantly higher than that in control group(χ~2= 90.396,P_(all)< 0.001). The positive rate of bacteria in infection group was signi?cantly higher than that in non-infection at delivery and 6 hours after delivery(P < 0.001), and the positive rate of bacteria in infection group at 6 hours after delivery was signi?cantly higher than that at 6 hours after delivery(P < 0.001). A total of 396 strains of pathogenic bacteria were detected in infection group, including 252 strains of Gram-negative bacteria, 141 strains of Gram-positive bacteria and 3 strains of fungi, Escherichia coli and Acinetobacter baumannii were the most Gram-negative bacteria, and Staphylococcus was the main Gram-positive bacteria. Conclusion During the bacterial culture of ear and throat swabs, the positive rate of bacteria is more valuable when the newborn transported to NICU 6 hours after delivery.
引文
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[13]王瑞芬,杨悦青,肖敏,等.宫腔内感染新生儿转运至新生儿监护病房过程中耳、咽拭子培养与发生新生儿感染的相关性[J].中国医药导刊,2017,19(5):448-449.
[14]陈婷,杨力,徐文君,等.新生儿葡萄球菌属感染分布与耐药性分析[J].中国实用儿科杂志,2014,14(1):52-54.
[15]付魏萍.新生儿葡萄球菌败血症细菌学分类及耐药性分析[J].国际检验医学杂志,2014,14(8):1071-1072.
[2]郭瑞霞,文海燕,耿庆红.NICU患儿病原菌感染与定植调查分析[J].中华医院感染学杂志,2015,25(9):2120-2122.
[3]李兆娜,王萍,寇晨,等.677例新生儿咽拭子细菌培养及病原菌的耐药性分析[J].微生物与感染,2017,12(5):294-298.
[4]陈俊华,张宏艳,孙夫强.新生儿咽拭子培养的临床意义[J].武警后勤学院学报(医学版),2012,21(2):95-97.
[5]童笑梅.新生儿血行感染[J].中国新生儿科杂志,2009,24(5):257-260.
[6]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006.
[7]杨启文,王辉.抗菌药物敏感性试验最新动向:2010年CLSIM100-S20主要更新内容[J].中华检验医学杂志,2010,33(6):488-491.
[8]Lee KY,Oh KW,Weon YC,et al.Neonatal seizures accompanied by diffuse cerebral white matter lesions on diffusionweighted imaging are associated with rotavirus infection[J].Eur J Paediatr Neurol,2014,18(5):624-631.
[9]陈斌,孙利华.运用多元Logistic回归模型分析影响NICU新生儿感染的危险因素[J].中国现代医生,2016,54(16):44-46.
[10]王丽青,金志彪,周茶香.NICU新生儿感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,15(1):80-81.
[11]李小琴,苗润燕.新生儿咽部致病菌携带状况与分娩方式相关性研究[J].中国妇幼健康研究,2016,27(3):382-383.
[12]高杰,李英,谌丽娟,等.NICU新生儿医院感染特点与病原菌分析[J].中华医院感染学杂志,2016,26(2):427-428.
[13]王瑞芬,杨悦青,肖敏,等.宫腔内感染新生儿转运至新生儿监护病房过程中耳、咽拭子培养与发生新生儿感染的相关性[J].中国医药导刊,2017,19(5):448-449.
[14]陈婷,杨力,徐文君,等.新生儿葡萄球菌属感染分布与耐药性分析[J].中国实用儿科杂志,2014,14(1):52-54.
[15]付魏萍.新生儿葡萄球菌败血症细菌学分类及耐药性分析[J].国际检验医学杂志,2014,14(8):1071-1072.