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新生儿败血症:三级护理医院新生儿重症监护病房中细菌病原体的临床特征、流行病学及抗生素敏感性模式

Neonatal Sepsis: Clinical characteristics, Epidemiology and Antibiotic Sensitivity Pattern of the Bacterial Pathogens in Neonatal Intensive Care Unit of a Tertiary Care Hospital.

作者信息

Moni S C, Mollah A H, Banerjee M, Khan T H, Sejuti A, Morshed S S

机构信息

Dr Sadeka Choudhury Moni, Associate Professor, Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

出版信息

Mymensingh Med J. 2020 Apr;29(2):366-375.

Abstract

Neonatal sepsis, a major newborn killer worldwide exhibits wide spectrum of clinical manifestations. Epidemiology and aetiological organisms vary with geographical area and time. Objective of the study was to study clinical characteristics, epidemiology, bacterial aetiology and drug sensitivity pattern of isolated organisms in Neonatal Intensive Care Unit (NICU), Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. This observational cross sectional study was carried out in NICU, DMCH from January 2014 to June 2015. The inclusion criteria were newborns having features of sepsis at admission or developing such features afterwards when admitted for other indications. A blood sample was collected aseptically immediately after clinical diagnosis and was sent for relevant laboratory investigations. Sample for culture sensitivity was inoculated bedside to culture bottle and sent to department of microbiology. The newborns were followed up till hospital discharge or death. All information regarding history, laboratory findings and follow up were recorded in a structured questionnaire. Of the 200 neonates, 59% were diagnosed as having late onset sepsis (LONS). Premature and low birth weight (LBW) babies mostly suffered from LONS. Respiratory distress, tachycardia, lethargy were the predominant symptoms in both early and late sepsis. Blood culture yielded growth in 55% of the septic newborns. Klebsiella pneumoniae was the predominant organism in both early and late sepsis. Most of the Gram negative bacteria were sensitive to colistin, meropenem and imipenem. Case fatality was 24.39% and 34.74% in early and late sepsis respectively.

摘要

新生儿败血症是全球主要的新生儿杀手,临床表现多种多样。其流行病学和致病微生物因地理区域和时间而异。本研究的目的是探讨孟加拉国达卡达卡医学院医院(DMCH)新生儿重症监护病房(NICU)中新生儿败血症的临床特征、流行病学、细菌病因及分离菌株的药敏模式。本观察性横断面研究于2014年1月至2015年6月在DMCH的NICU进行。纳入标准为入院时具有败血症特征或因其他指征入院后出现此类特征的新生儿。临床诊断后立即无菌采集血样,送相关实验室检查。将培养敏感性样本在床边接种到培养瓶中,送至微生物学系。对新生儿进行随访直至出院或死亡。所有关于病史、实验室检查结果和随访的信息都记录在一份结构化问卷中。在200名新生儿中,59%被诊断为晚发性败血症(LONS)。早产和低出生体重(LBW)婴儿大多患LONS。呼吸窘迫、心动过速、嗜睡是早发性和晚发性败血症的主要症状。55%的败血症新生儿血培养有细菌生长。肺炎克雷伯菌是早发性和晚发性败血症的主要致病菌。大多数革兰氏阴性菌对黏菌素、美罗培南和亚胺培南敏感。早发性和晚发性败血症的病死率分别为24.39%和34.74%。

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