Wu Jun-Ho, Chen Chien-Yi, Tsao Po-Nien, Hsieh Wu-Shiun, Chou Hung-Chieh
Department of Pediatrics, Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan.
Pediatr Neonatol. 2009 Jun;50(3):88-95. doi: 10.1016/S1875-9572(09)60042-5.
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.
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.
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, while very low 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%).
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.
新生儿败血症是新生儿重症监护中最严重的问题，会导致显著的发病率和死亡率。我们评估了台湾一家医学中心新生儿败血症的致病病原体、药物敏感性、血液学参数、临床病程及死亡率，并将我们的结果与台湾此前的研究结果进行比较。
纳入2001年1月至2006年12月在台湾大学附属医院新生儿重症监护病房（NICU）住院的新生儿。若培养结果分别在出生后7天内或之后呈阳性，则将患者分为早发型败血症组和晚发型败血症组。
100例新生儿共发生109次败血症发作。败血症在所有NICU入院病例中的发生率为4.06%。大多数早发型败血症新生儿为足月儿，而极低出生体重儿（VLBW）和早产儿占晚发型败血症病例的大多数。在早发型败血症中，最常见的致病病原体包括B组链球菌（GBS）（36%）和大肠杆菌（E. coli）（26%）。与大肠杆菌相比，GBS与更多的脑膜炎受累相关，但死亡率较低。晚发型败血症中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%）。早发型败血症的败血症相关死亡率（10%）高于晚发型败血症（7%）。
与台湾此前的报告不同，在本研究中，GBS被发现是早发型败血症的主要病原体。台湾应采用GBS筛查和产时抗生素预防指南来预防早发型新生儿败血症。晚发型败血症最常见的致病微生物是CONS和念珠菌属。近平滑念珠菌与高死亡率相关。
