Division of Neonatology, Chang Gung Children's Hospital, School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
Pediatr Neonatol. 2012 Aug;53(4):228-34. doi: 10.1016/j.pedneo.2012.06.003. Epub 2012 Jul 23.
Neonatal sepsis contributes to great mortality and morbidity among very-low-birth-weight (VLBW) infants. Prevalence and pathogen distribution of sepsis in the neonatal intensive care units (NICUs) vary with time and geographic location. Such information serves as a guide for selection of empirical antibiotics coverage.
This is a case series study performed by retrospective chart review of VLBW infants (birth body weight, BBW, <1500 g) in a medical center during a 5-year period from January 2005 to December 2009. Episodes of positive blood cultures, pathogen distribution and related clinical manifestations were described.
A total of 158 episodes of sepsis were identified from 1042 VLBW infants. Sepsis rate was 152 per 1000 live births. The vast majority of infections (60.7%) were caused by Gram-positive organisms [G(+)], and overall Coagulase-negative staphylococci (CoNS) (52.5%) were the most common pathogen identified. Prevalence for early-onset sepsis (EOS) was 1% and for late-onset sepsis (LOS) was 14.2%. Infants with EOS had a much higher case fatality rate than LOS (40% vs. 4.7%). Escherichia coli (40%) were the leading pathogen of EOS while CoNS (54.7%) was the leading pathogens of LOS. Overall, apnea and/or bradycardia and/or cyanosis (65.8%), poor activity (48.7%), and increased respiratory effort (43.0%) were the most common presenting features of sepsis.
Unlike term infants, Gram-negative organism and E coli were the leading pathogen of EOS among VLBW infants. Judicious and timely use of antibiotic therapy is crucial in the care of VLBW infants.
新生儿败血症是极低出生体重（VLBW）儿死亡和发病的主要原因。新生儿重症监护病房（NICU）败血症的流行率和病原体分布随时间和地理位置而异。此类信息可作为经验性抗生素覆盖选择的指南。
这是一项病例系列研究，通过回顾性病历审查，对 2005 年 1 月至 2009 年 12 月期间一家医疗中心的 VLBW 婴儿（出生体重<1500g）进行了 5 年的研究。描述了阳性血培养物的发作、病原体分布和相关临床表现。
从 1042 名 VLBW 婴儿中确定了 158 例败血症发作。败血症发生率为每 1000 例活产儿 152 例。绝大多数感染（60.7%）由革兰氏阳性菌（G+）引起，总体凝固酶阴性葡萄球菌（CoNS）（52.5%）是最常见的病原体。早发性败血症（EOS）的发生率为 1%，晚发性败血症（LOS）的发生率为 14.2%。EOS 患儿的病死率明显高于 LOS（40%比 4.7%）。EOS 的主要病原体为大肠埃希菌（40%），而 LOS 的主要病原体为 CoNS（54.7%）。总体而言，呼吸暂停和/或心动过缓/或发绀（65.8%）、活动不佳（48.7%）和呼吸努力增加（43.0%）是败血症最常见的表现特征。
与足月婴儿不同，革兰氏阴性菌和大肠埃希菌是 VLBW 婴儿 EOS 的主要病原体。在 VLBW 婴儿的治疗中，明智和及时地使用抗生素治疗至关重要。
