The Clinical Features And Analysis Of Drug Resistence In Neonatal Sepsis

Objective:To investigate clinical features and drug resistance of neonatal sepsis,guiding diagnosis and clinical medication.Methods:All positive blood culture reports from newborns during 2007-2014 were recorded. Neonatal sepsis was differentiated into early-onset sepsis (EOS,≤72h) and late-onset sepsis (LOS,>72h).The clinical data and sensitivity patterns of neonatal sepsis were analyzed.Results:The incidence of LOS increased over time.The incidence rate of jaundice,skin petechia,low response & poor feeding,cyanosis,poor peripheral circulation and dyspnea in EOS was higher than that in LOS respectively,while the incidence of fever(body temperature>38℃) and apnea in LOS was higher than that in EOS,with statistical difference(P<0.05,chi-square test).A total of 159 episodes(26.2%) were isolated in 155 EOS cases/with a total of 449 episodes(73.8%) isolated in 435 EOS cases.Gram-positive bacteria predominated in both two groups,whose incidence were more than 50%, and followed by gram-negative bacteria and fungi.The incidence of gram-positive bacteria isolating from neonatal sepsis decreased over time,while gram-negative and fungi increased over time. Coagulase negative Staphylococcus(CNS) was the leading pathogen of EOS and LOS,however the incidence of CNS in LOS was higher than that in EOS. There was significant difference in comparison of fungi and Listeria between the two groups(P<0.05,chi-square test).In gram-negative bacteria,E. coli and Klebsiella predominated.The detection rate of E. coli in EOS and LOS were 16.4%,13.4%respectively,and the detection rate of Klebsiella were 11.9%,14.9%respectively.The resistance to tienam, piperacillin/tazoba-ctam and amikacin of Klebsiella and E. coli was low,while more than 80% were resistant to ampicillin and piperacillin.The resistance to ampicillin,penicillin,piperacillin and erythromycin of CNS were more than 80%,and a total of 144 isolates from methicillin-resistant coagulase-negative Staphylococci(MRCNS) were detected in 168 cases of CNS septicemia. The resistance to oxacillin, erythromycin and tetracycline of Enterococcus was high(52.9%-94.1%). CNS and Enterococcus were 100%sensitive to vancomycin.Conclusions:Patients with LOS and EOS have difference in pathogenic distribution and clinical manifestations,with multiple resistant bacteria producing. The reasonable choice of medication should be selected based on the susceptibility test results.The high degree of antibiotic resistance calls for reduction in preventive medication, surveillance system and management.