Analysis Of Diagnosis And Treatment And Pathogenic Bacteria Of Neonatal Purulent Meningitis In A Large Third-tier Children's Hospital In Southwest China During The Past 12 Years

Objectives:The characteristics of diagnosis and treatment of neonatal purulent meningitis(NPM)and the changes of pathogenic bacteria were analyzed in order to provide a new and useful reference for the treatment of neonatal purulent meningitis.Methods:From January 2007 to December 2018,the clinical data of 438 neonates with purulent meningitis diagnosed were retrospectively analyzed,including general condition,laboratory examination,treatment,pathogenic bacteria and drug resistance,etc.According to the onset time,they were divided into three groups:January 2007 to December 2010(group A),January 2011 to December 2014(group B),January 2015 to December 2018(group C).The clinical data were expressed by counting and measuring data,and the measured data were measured by t-test or variance test.The difference between the two groups of data was compared by?2 test or fisher exact probability method.Results:More than 50%of NPM is male children,full-term infants,birth weight of 2500g to 4000g and natural childbirth.The main perinatal problem is preterm rupture of membranes(25.5%)and amniotic fluid abnormalities(26.7%).The age of onset was less than 3 days,the age of admission was more than 7 days,admission in the period of January 2015to December 2018 has been seen in more than 50%of NPM.The main incidence was fever(46.8%),respiratory abnormality(30.1%),convulsion(17.1%),and the physical signs were weakened or disappeared of primary reflex(79.2%),poor response(67.3%)and decreased crying(49.5%).The increase rate of C-reactive protein value was 50.5%.In the most of the NPM,The highest number of nucleated cells in cerebrospinal fluid(CSF)was not more than 50×10~6/L in the course of disease,and the highest protein value in cerebrospinal fluid(CSF)was less than 2g/L during hospitalization.Penicillin,piperacillin tazobactam,piperacillin sulbactam,ceftazidime,oxycephalosporium,chlorphenamine,meropenemand vancomycin was the most commonly used antibiotic.Most of the patients with NPM were discharged from hospital after treatment.The positive rate of pathogen was 24.8%in the treatment group,mainly empirical treatment(75.1%),the improvement rate of first-line treatment was 41.5%,and the average treatment time was 24.45.Days.The C-reactive protein(CRP)and cerebrospinal fluid protein(CSF)were significantly increased in the NPM improvement group,and the treatment time was longer than that in the experienced treatment group.The empirical first-line treatment of piperacillin-tazobactam/piperacillin-sulbactam,ceftazidime,oxycephalosporium and penicillin were the main first-line antibiotics in the treatment group,which was consistent with the empirical treatment regimen,and there was no significant difference between the two groups(P<0.05).It is suggested that the empirical treatment of NPM is effective when the etiology is not clear.There were significant differences in treatment time,first-line treatment rate,empirical treatment time and proportion of first-line treatment in group A,group B and group C(P<0.05).In the last 8 years,the treatment time in the improvement group was shortened,and the proportion of first-line treatment,especially in the empirical treatment group,was gradually increased.The time of onset,gestational age,fever,convulsion,the number of nucleated cells in cerebrospinal fluid,the amount of protein in cerebrospinal fluid and the time of treatment were significantly different between the empirical second-line treatment group and the first-line treatment group(P<0.05).The etiology of the three groups of children were compared,fever ratio,Gram The percentage difference of positive bacteria was statistically significant.Escherichia coli was the most common pathogen in 12 years,but it was found that Klebsiella pneumoniae was the most common pathogen in the late-onset group of premature infants in newborn brain,and the incidence of Streptococcus pneumoniae(mainly Streptococcus actinosus)increased gradually.The resistance rates of Gram-negative bacteria to cefmezole,cefuroxime,cefotaxime and ceftazidime showed a tendency of first rising and decreasing,and in the last 4 years,the drug resistance rate was about 50%,and similar trend was observed to Tanneng and imipenem,and the overall drug resistance rate was still very low.The resistance rate to piperacillin tazobactam was not high,and the resistance rate of gram-positive bacteria to penicillin was decreased year by year,and in recent years,the resistance rate of gram-positive bacteria to penicillin decreased year by year.Fluctuating at about 50%,no resistant strains to vancomycin and teicoplanin were found.Conclusions:The clinical diagnosis of NPM is difficult,its clinical symptoms and signs are not specific,it is difficult to diagnose clinically,we must rely on the examination of cerebrospinal fluid to confirm the diagnosis.The early empirical treatment of BPM is effective and can shorten the treatment time,the commonly used broad-spectrum antibiotic penicillin,In the third generation of cephalosporium,piperacillin tazobactam and oxycephalosporium were effective,and the effective rate increased gradually in recent years,and the treatment time was shortened gradually.When the cerebrospinal fluid index of some children is obviously elevated,second-line treatment is needed as soon as possible.The proportion of coagulase-negative staphylococci decreased,and the incidence of non-Streptococcus lactococcus and Klebsiella pneumoniae NPM increased gradually.Purulent brain The resistance rate of Gram-positive bacteria to penicillin was about 50%.Vancomycin,dinazolamine,teicoplanin and tegacycline were not found to be resistant to vancomycin,linecarbamide,teicoplanin and tegacycline,and the resistance rate of penicillin was about 50%.The resistance rate of gram-negative bacteria to cephalosporins was about 50%and the susceptibility to carbapenems was higher.