摘要
目的探讨新生儿李斯特菌败血症的临床特征以及药敏试验特点。方法回顾性分析2013年3月至2017年3月间在湖州市妇幼保健院住院的11例李斯特菌败血症新生儿的细菌培养、药敏试验、抗生素治疗等临床资料，并追溯患儿母亲分娩前产单核细胞增生李斯特菌（Listeria monocytogenes，LM）感染病史。结果11例李斯特菌败血症患儿母亲分娩前均有发热史，其中9例分娩时伴有不同程度羊水胎粪污染。11例患儿的主要临床表现为呼吸困难（11／11）、发热（10／11）、呼吸暂停（9／11）、反应及吃奶差（9／11）、惊厥（6／11）、呕吐伴腹胀（2／11）、肺出血（1／11）、进行性加重的黄疸（1／11）、全身出血点（1／11）；血常规结果均有异常，降钙素原及C-反应蛋白水平均增高。10例接受脑脊液检查的患儿中，7例异常。从患儿外周血和脑脊液，以及母亲外周血、宫颈分泌物标本中共培养分离出17株LM。对17株LM进行了12种抗生素的药敏试验，结果显示，对哌拉西林他唑巴坦、氨苄西林舒巴坦、美罗培南、万古霉素、复方新诺明、环丙沙星、庆大霉素的敏感率均为17／17；对青霉素、氨苄西林、红霉素、克林霉素敏感率分别为10／17、11／17、9／17和8／17；对苯唑西林耐药率为17／17。11例李斯特菌败血症患儿分别经哌拉西林他唑巴坦、美罗培南、万古霉素抗感染治疗，临床痊愈率10／11，好转率11／11。所有患儿分别于出院1周及1个月电话随访，其中2例失访，其余随访患儿的一般情况均良好。结论新生儿李斯特菌败血症病情重、进展快，临床表现以呼吸困难、发热等为主，化脓性脑膜炎发生率高。青霉素类单制剂抗生素对LM部分耐药，而哌拉西林他唑巴坦等青霉素类复合制剂及美罗培南、万古霉素的抗感染效果理想。
Objective To investigate the clinical features and antimicrobial susceptibility of neonatal Listeria septicemia. Methods Eleven cases of neonatal Listeria septicemia that were treated in the Huzhou Maternity and Children Health Hospital from March 2013 to March 2017 were enrolled in this study. Clinical data including the results of bacterial culture, antimierobial susceptibility test and antibiotic treatment were collected and retrospectively analyzed. Moreover, maternal history ofListeria monocytogenes （LM） infection before delivery was retrieved. Results All of the 11 mothers had fever before delivery and nine of them showed different grades of amniotie fluid contamination during delivery. Clinical symptoms of the 11 neonates included dyspnea （11 cases）, fever （ten cases）, apnea （nine cases）, slow response and feeding difficulty （nine cases）, convulsion （six cases）, vomiting and abdominal distension （two cases）, pulmonary hemorrhage （one case）, progressive jaundice （one case） and systemic skin bleeding point （one case）. All cases showed abnormal results of blood routine test and increased calcitonin and C-reactive protein. Ten cases received cerebrospinal fluid examination, seven of which were abnormal. Altogether 17 strains of LM were isolated from various specimens. These strains were all sensitive to piperacillin-tazobactam, ampieillin-sulbactam, meropenem, vancomycin, eotrimoxazole, ciprofloxacin and gentamycin, but resistant to oxaeillin. Strains those were sensitive to penicillin, ampicillin, erythromyein and clindamycin accounted for 10/17, 11/17, 9/17 and 8/17, respectively. The 11 neonates were treated with piperacillin-tazobaetam, meropenem or vancomycin. All of them improved （11/11） and ten were cured （10/11）. All cases were followed up through phone calls at one week and one month after discharge. Two were lost to follow-up, while the others were all in good condition. Conclusions Neonatal Listeria septicemia is usually a severe disease characterized by rapid progression and mainly presented with dyspnea and fever, besides there is a high possibility of purulent meningitis. Some LM strains are resistant to single-agent penicillin antibiotics. However, antibiotics such as piperacillin tazobactam, meropenem and vancomycin are effective in the treatment of neonatal L＆teria septicemia.
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2018年第3期191-197,共7页
Chinese Journal of Perinatal Medicine
