The Study Of Clinical Feature And Pathogenic Bacterium Of 140 Cases Of Neonatal Bacterial Pneumonia

Objective:Summarize the clinical manifestation,pathogen distribution,drug sensitive test and bacterial drug resistance of neonatal bacterial pneumonia,and analyze the correlation between the emergence of ESBLs positive bacteria and use of antibiotics especially third-generation cephalosporins,in order to provide a clinical basis for the diagnosis and therapy of neonatal bacterial pneumonia.Methods:Retrospective analyze 140 cases of neonatal bacterial pneumonia cases information,summarize its route of Infection,clinical manifestations,accessory examination,pathogen distribution,drug sensitive test and bacterial drug resistance,treatment and outcome,expore the correlation between the emergence of ESBLs positive bacteria and use of antibiotics especially third-generation cephalosporins.Results:1.In 140 cases,64.3% infected after birth,including respiratory tract infections 53.6%.2.In common symptoms and signs,tachypnea 90.0%,lips cyanosis 78.6%,bucking 42.9% and regurgitating milk 45.7%,but fever 27.1%,cough 35.7% and moist rales 17.9% . In common complications ,hyperbilirubinemia 37.9%,diarrhoeal diseases 30.0%,other infectious disease 20.0%,respiratory failure 4.3% and heart failure 1.4%.3.Routine blood test results showed WBC raise 44.3% and N raise 55.7%.X-ray film of the chest showed abnormal 96.5%,including flocculent shadow 70.2% and with hyperinflation 74.6%.4.In 166 bacterial strain,G- bacteria 91%,including klebsiella pneumoniae 36.1%,escherichia coli 12.0%,enterobacter cloacae 11.4%,acinetobacter baumannii 10.2% , pseudomonas aeruginosa 6.0% ; G+ bacteria 9.0%,including staphylococcus aureus 8.4%.5.In pathogenic bacterium of prepartum infectious pneumonia ,klebsiella pneumoniae 43.2%,acinetobacter baumannii 27.0%,escherichia coli 18.9%;in pathogenic bacterium of intrapartum infectious pneumonia,klebsiella pneumoniae 53.8%,escherichia coli 30.8%;in pathogenic bacterium of postpartum infectious pneumonia,klebsiella pneumoniae 44.4%,enterobacter cloacae 17.8%,escherichia coli 15.6%,staphylococcus aureus 11.1% and pseudomonas aeruginosa 5.6%.6.The drug resistant rates of primary G- bacteria to ampicillin,piperacillin,cephazoline,cefotaxime,ceftazidime,cefepime and aztreonam were 55%-98.3% , to piperacillin/tazobactam was 5%-26.7% , and to meropenem,imipenem were 0.The drug resistant rates of staphylococcus aureus to oxacillin was 7.1% and to vancomycin was 0.7.Higher ESBLs detection rate of pathogenic bacteria were klebsiella pneumoniae 60% and escherichia coli 60%.8.Utilization ratio of antibiotics especially third-generation cephalosporins in children infected ESBLs positive bacteria significantly higher than the ratio in children infected ESBLs negative bacteria (P<0.01).9.All cases were discharged cured or improved,cured cases 62.1%,improved cases 37.9%(including against-advice discharge cases 32.1%),average course of treatment was 11.3 days.Conclusion:1.Neonatal bacterial pneumonia mostly infected after birth,especially infected through respiratory tract.2.Clinical manifestations was usually atypical , tachypnea , lips cyanosis,bucking and regurgitating milk were common,but fever,cough and moist rales were less common . Common complications were hyperbilirubinemia,diarrhoeal diseases,other infectious disease,respiratory failure and heart failure.3.Half of the routine blood test showed N raise.X-ray film of the chest often showed abnomal , flocculent shadow with hyperinflation was common. 4.In pathogenic bacterium , G- bacteria especially klebsiella pneumoniae were the most common,and the most common G+ bacteria were staphylococcus aureus.5.The pathogenic bacterium of prepartum and intrapartum infectious pneumonia mostly were G- bacilli,the pathogenic bacterium of postpartum infectious pneumonia mostly were G- bacilli and staphylococcus aureus.6.The drug resistant rates of G- bacteria to penicillins,cephalosporins,and monocyclicβ-lactam antibiotic were high,However,their compound of addingβ-lactamase inhibitor agents was relatively low resistance,and all G- bacteria were sensitive to carbapenem antibiotics.Staphylococcus aureus were resistant to oxacillin on the low rate and sensitive to vancomycin.7.Detection rate of ESBLs in klebsiella pneumoniae and escherichia coli were high.8.correlation exist between the emergence of ESBLs positive bacteria and use of antibiotics especially third-generation cephalosporins.9.After aggressive treatment,the majority got good prognosis.