医学伦理研究进展
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摩洛哥新生儿重症监护室爆发粘质沙雷氏菌

阿卜杜拉蒂夫·达乌迪

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介绍：新生儿重症监护病房中的院内感染因其引起的发病率和死亡率仍然是一个公共卫生问题。*最常见的病原体是属于革兰氏阴性杆菌 (GNB) 家族的肠杆菌科细菌，尤其是在发展中国家，它们占病例的 51.5%。在GNB中，粘质沙雷氏菌（S. marcescens）是一种普遍存在的条件致病菌，其环境根除非常困难。新生儿中粘质沙门氏菌的院内感染很少见，通常被描述为暴发。新生儿感染可出现肺炎、菌血症、结膜炎、尿路感染，甚至胃肠炎等，这些感染的结局往往很严重，发病率和死亡率很高；由此可见，发起的重要性，一旦诊断出这种病菌，就会在传播前采取控制措施，效果非常惊人。本研究的目的是分享我们因这种细菌引起的医院感染的经验，并通过文献综述来显示这种细菌的严重性

  

Background: Nosocomial infections in neonatal intensive care units are a public health problem because of their heavy consequences on morbidity and mortality and the important cost they generate. S. marcescens has emerged as a currently recognized pathogen for nosocomial infection in neonates, especially in epidemic for, which has also been reported in our experience. We collected 8 cases of S. marcescens bacteremia for 2 months. A similar report was published in 2010 by Gulcin Bayramoglu et al., comprising 9 cases, in neonatal intensive care unit over a period of 36 days

 

Method:- This is a descriptive retrospective study, performed in the neonatal intensive care unit (NICU) of Mohammed VI University Medical Hospital, Marrakesh, Morocco. During the epidemic period of this germ, July and August 2016, the population in our study included neonates hospitalized in the NICU, whose postnatal age ranged from 0 to 28 days with the diagnosis of nosocomial infection of S. marcescens, which was made by the positivity of bacteriological samples at least 48 hours after admission to our NICU. Data collection was done using an individual record. The literature review was done on PubMed including writings describing Serratia marcescens outbreaks in neonates in the NICU.

 

Results: We collected eight cases, which were included during the study period, July and August 2016, which corresponded to the epidemic period of S. marcescens bacteremia. The epidemic began in early July 2016 in a premature 33.9 GA admitted for hyaline membrane disease, which showed after 3 days of his hospitalization signs of sepsis with isolation of Serratia marcescens in the blood culture, and other cases were diagnosed throughout the July period. The mean gestational age of our patients was 36 weeks (wk), with extremes ranging from 33.2 to 40.8 wk. Newborns were premature in 75% of cases. The sex ratio (boy/girl) was 3. The weight ranged from 1130 grams to 3600 grams with an average weight of 1853 grams. Hyaline membrane disease was the most diagnosis of hospitalization in 62.5% of cases and neonatal pulmonary infection in 37.5% of cases. On admission, all patients were treated with ceftriaxone and gentamicin antibiotics, and 87.5% of cases were artificially ventilated. The diagnosis of nosocomial infection was made over an average of 7 days of hospitalization, with extremes ranging from 3 days to 12 days. The diagnosis was made in the presence of clinical signs and/or biological abnormalities on the hemogram or ascension C-reactive protein with S. marcescens-positive blood cultures. Isolated S. marcescens strains were susceptible in 75% of cases to 3rd generation cephalosporins and all susceptible to imipenem, to ciprofloxacin, and to aminoglycosides (amikacin and gentamicin), but all were resistant to colistin. After diagnosis of nosocomial S. marcescens infection, all patients were treated with imipenem and amikacin. The outcome was favorable in 37.8% of the cases, and the death was reported in 62.5%. The average hospital stay was 22.75 days, with extremes ranging from 12 days to 34 days.

 

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Abdellatif Daoudiis 在摩洛哥马拉喀什穆罕默德六世大学医学院母婴中心新生儿重症监护室工作。