Neonatal Sepsis: A 6-Year Analysis in a Neonatal Care Unit in Taiwan
Neonatal Sepsis: A 6-Year Analysis in a Neonatal Care Unit in Taiwan
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DOI：
10.1016/s1875-9572(09)60042-5
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发表时间：
2009-06-01
影响因子：
2.1
通讯作者：
Chou, Hung-Chieh
中科院分区：
文献类型：
--
作者：
Wu, Jun-Ho;Chen, Chien-Yi;Chou, Hung-Chieh
背景：新生儿败血症是新生儿重症监护中最严重的问题，导致严重的发病率和死亡率。我们评估了台湾某医学中心新生儿败血症的病原学、药物敏感性、血液学参数、临床病程和死亡率，并将我们的研究结果与在台湾进行的研究结果进行了比较。方法：研究对象为2001年1月至2006年12月在台大医院新生儿重症监护室(NICU)住院的新生儿。根据新生儿出生后7天内或出生后7天内细菌培养呈阳性，将患者分为早发型败血症和迟发性败血症。结果：在100例新生儿中，共有109例败血症。在所有NICU患者中，败血症发生率为4.06%。早发性败血症新生儿多为足月儿，晚发性败血症以白色两胎体质量(VLBW)和早产儿居多。在早发性败血症中，最常见的致病菌包括B组链球菌(GBS)(36%)和大肠埃希氏菌(26%)。与大肠杆菌相比，GBS与更多的脑膜炎受累有关，但死亡率更低。迟发性脓毒症最常见的致病微生物是凝固酶阴性葡萄球菌(CONS)(40%)和念珠菌(15%)。早发性脓毒症的脓毒症相关死亡率(10%)高于晚发性脓毒症(7%)。结论：与台湾以往的报道不同，本研究发现GBS是早发性脓毒症的主要病原体。台湾应采用GBS筛查及产期抗生素预防指南，以预防早期新生儿败血症。迟发性脓毒症最常见的致病微生物是CONS和念珠菌。近平假丝酵母菌感染与高死亡率相关。
Background: Neonatal sepsis is the most serious problem in neonatal intensive care, resulting in significant morbidity and mortality. We evaluated the causative pathogen, drug sensitivity, hematological parameters, clinical course and mortality rate of neonatal sepsis in a Taiwanese medical center and compared our results to those of previous studies conducted in Taiwan.Methods: Neonates admitted to the neonatal intensive care unit (NICU) at National Taiwan University Hospital (NTUH) between January 2001 and December 2006 were included in this study. Patients were divided into early-onset sepsis and late-onset sepsis groups if their culture tested positive within the first 7 days of life or later, respectively.Results: A total of 109 episodes of sepsis were identified in 100 neonates. The incidence of sepsis was 4.06% among all NICU admissions. Most neonates with early-onset sepsis were term infants, white very tow birth weight (VLBW) and preterm infants accounted for the majority of cases of late-onset sepsis. In early-onset sepsis, the most common pathogens responsible included group B streptococci (GBS) (36%) and Escherichia coli (E. coli) (26%). GBS was associated with more meningitis involvement but lower incidence of mortality compared with E. coli. The most common causative microorganisms in late-onset sepsis were coagulase-negative staphylococci (CONS) (40%) and Candida (15%). The sepsis-related mortality rates were higher in early-onset sepsis (10%) than in late-onset sepsis (7%).Conclusion: Unlike previous reports from Taiwan, in the present study, GBS was found to be the leading pathogen in early-onset sepsis. GBS screening and intrapartum antibiotic prophylaxis guidelines should be used in Taiwan to prevent early neonatal sepsis. The most common causative microorganisms of late-onset sepsis were CONS and Candida species. Candida parapsilosis was associated with a high mortality rate.