新生儿B族链球菌侵袭性感染54例临床分析

doi:10.3969/j.issn.2095-9400.2021.04.006

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摘要目的：探讨新生儿B族链球菌（GBS）侵袭性感染的临床特征、围产期危险因素、耐药性、治疗及归转。方法：收集2014年1月至2020年6月温州医科大学附属第二医院育英儿童医院新生儿科收治的54例经血液、脑脊液等无菌腔隙培养确诊为GBS侵袭性感染的新生儿的临床资料，回顾性分析其围产期危险因素、临床表现、体外药物敏感试验结果、治疗与归转。结果：54例新生儿GBS侵袭性感染患儿中早发型感染28例，晚发型感染26例。13例在血液和脑脊液样本中同时检出GBS，36例仅在血液中检出GBS，4例仅在脑脊液中检出GBS。早发型感染以发绀、呻吟、气促及发热为主要症状，易合并肺炎，少数合并化脓性脑膜炎；晚发型感染以发热、喂养差为首发症状，易合并化脓性脑膜炎。早发型宫内感染比例高于晚发型，差异有统计学意义（P＜0.05）；死亡的3例新生儿均有一项或多项围产期危险因素。GBS药敏结果显示对青霉素、氨苄青霉素、万古霉素、利奈唑胺均100%敏感。经治疗后，47例治愈出院，4例未愈出院（家属放弃治疗），3例死亡（均为早发型，病死率5.5%）。平均住院时间（25.5±15.6）d。结论：对GBS侵袭性感染的新生儿，根据临床特征应尽早行实验室病原学检查以明确诊断，将青霉素作为首选用药，后根据病情联合其他抗生素抗感染。围产期危险因素可能为新生儿GBS感染的重要危险因素，对孕妇开展GBS筛查和产时抗生素预防措施可有效降低新生儿GBS感染的发生。

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	刘佳慧
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	杨锦红
	金速速
	李方去

关键词 ：新生儿, B族链球菌, 链球菌感染, 化脓性脑膜炎, 围产期

Abstract：Objective: To explore the clinical characteristics, perinatal risk factors, drug resistance, treatment and regression of neonatal group B streptococcus (GBS) invasive infection. Methods: Clinical data of 54 neonates, who were admitted to the department of neonatology from January 2014 to June 2020, diagnosed with GBS invasive infection by sterile lacunar culture of blood and cerebrospinal fluid were collected and their perinatal risk factors, clinical manifestations, in vitro drug sensitivity test results, treatment and return were retrospectively analyzed. Results: Of 54 infants with GBS invasive infection, 28 had early-onset infection and 26 had late-onset infection. GBS was detected in both blood and cerebrospinal fluid samples in 13 cases, while GBS was detected only in blood in 36 cases and only in cerebrospinal fluid in 4 cases. Early-onset infections had cyanosis, groaning, shortness of breath and fever as the main symptoms, and were prone to pneumonia, and a small number of them have purulent meningitis. Late-onset infections had fever and poor feeding as the first symptoms, and were easily associated with purulent meningitis. The proportion of early-onset intrauterine infection was higher than late-onset, with significant difference (P<0.05). Three newborns who died had one or more perinatal risk factors. GBS drug susceptibility results showed 100% sensitivity to penicillin, ampicillin, vancomycin, and linezolid. After treatment, 47 cases were cured and discharged, 4 cases were discharged unhealed (due to family give-up), and 3 cases died (all early onset, with fatality rate of 5.5%). The average length of hospital stay was (25.5±15.6)d. Conclusion: For neonates with invasive GBS infection, laboratory pathogenic examinations should be performed according to the clinical characteristics as soon as possible to confirm the diagnosis. Penicillin should be the first choice, and combined with other antibiotics to fight against the infection according to the condition. Perinatal risk factors may be important for neonatal GBS infection. GBS screening and intrapartum antibiotic prevention (IAP) measures for pregnant women can effectively reduce the incidence of neonatal GBS infection.

Key words： neonate group B streptococcus streptococcal infection purulent meningitis perinatal period

收稿日期: 2020-10-20

基金资助:温州市科技计划项目（Y20190391）。

通讯作者: 李方去，副主任技师，Email：1750326702@qq.com。 E-mail: 1750326702@qq.com

作者简介: 刘佳慧，检验师，Email：524444230@qq.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.04.006 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I4/287

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