Clinical Characteristics And Pathogenic Analysis Of Early-onset Neonatal Septicemia And Late-onset Neonatal Septicemia

Objective:To analyze and compare the clinical features,pathogens and drug resistance of neonatal early-onset sepsis and late-onset sepsis,and to guide the clinical diagnosis and treatment of neonatal sepsis.Methods:Retrospective analysis of clinical characteristics,pathogen culture results and drug susceptibility results of children diagnosed with neonatal sepsis in the neonatal intensive care unit(NICU)from January 2013 to December 2018,according to the age of onset For the early-onset sepsis group and the late-type sepsis group,the results of the two groups were statistically analyzed.Results:1.The prevalence of NOS in our hospital in the past 6 years is slightly higher than domestic reports,and there is an upward trend in recent years.The ratio of male to female infants is about 1.8:1.Preterm birth,low birth weight,premature rupture of membranes,amniotic fluid contamination and deep venous catheterization were statistically significant between EOS and LOS groups(p<0.05).2.Abdominal anesthesia and abnormal body temperature are common clinical manifestations of NOS.There are statistical differences between body temperature,pathological jaundice,irregular breathing,and apnea.A total of 215 patients(69.0%)with respiratory infection were found to have statistically significant differences in respiratory infection,umbilical inflammation,and purulent meningitis between the two groups(p<0.05).In the laboratory examination,69 patients(22.2%)had abnormal white blood cell(WBC)count,140(45.0%)had elevated C-reactive protein(CRP),and 59(19.0%)had decreased platelet count(PLT).There was a statistically significant difference in platelet count between groups(p<0.05).3.Among the clinical outcomes,51 patients(63.8%)improved EOS,9 patients(11.2%)died,171 patients(74.0%)improved in the LOS group,and 19 patients(17.7%)died.There was no significant difference in clinical outcome between the two groups(p>0.05).4.A total of 309 pathogenic bacteria were cultured in 311 children with sepsis,including 192 Gram-positive bacteria(G~+)(62.1%),95 Gram-negative bacteria(G~-)(30.7%),and 22 fungi(7.1%).).A total of 78 pathogenic bacteria were cultured in EOS.The main strains were:18 strains of Staphylococcus epidermidis(23.1%),8strains of Staphylococcus aureus(10.3%),6 strains of Escherichia coli and 6 strains of Klebsiella(7.6%).A total of 231 pathogens were cultured in 231 cases of LOS.The main strains were 71 strains of Staphylococcus epidermidis(30.7%),21 strains of Staphylococcus aureus(9.0%),43 strains of Escherichia coli(18.6%),Klebsiella.15strains(6.5%).There was a statistically significant difference between the two groups in fungal comparison(p<0.05).Compared with the three years before and after,the detection rate of G~+bacteria decreased in all types of sepsis,and the detection rate of G~-bacteria and fungi increased in all types of sepsis.There was no statistically significant difference between EOS group and LOS group between G~+bacteria,G~-bacteria and fungi(p>0.05).5.Analysis of drug susceptibility results of major pathogens,89 strains of Staphylococcus epidermidis in G~+bacteria were 100%resistant to penicillin,ampicillin,oxacillin,cephalosporin antibiotics,beta lactamase inhibitor complex,macrocyclic The resistance rate of ester antibiotics is over 80%.One strain(14.3%)of vancomycin-resistant Staphylococcus aureus was detected in strains resistant to linezolid and teicoplanin.The resistance rate of 49 strains of Escherichia coli to penicillin antibiotics was higher in G~-bacteria,and the resistance rates to ampicillin and piperacillin were 77.6%and 83.7%,respectively.It is sensitive toβ-lactamase inhibitor complexes,carbapenems,and aminoglycoside antibiotics.No strains resistant to carbapenems were detected.No resistant fungal strains were found.Conclusion:1.Male are more likely to suffer from NOS than Female.Mothers premature rupture of membranes,amniotic fluid contamination are more prone to EOS.2.Pathological jaundice is the most common clinical manifestation of EOS,and food intake is the most common clinical manifestation of LOS.Clinical manifestations such as abnormal body temperature,pathological jaundice,irregular breathing,and apnea are more likely to occur in EOS.Respiratory tract infections are the most common local infections in EOS and LOS.EOS is more likely to occur with umbilical inflammation and purulent meningitis.CRP has better diagnostic value than PLT and WBC,and EOS is more prone to lower PLT count.3.The pathogens of NOS in our hospital are mainly G~+bacteria(mainly CoNS).Escherichia coli and Klebsiella are more common in G~-bacteria,and fungi are white in long-term hospitalized children.Candida mainly.Compared with the three years before and after,the proportion of EOS and LOS G~+infections decreased,and the proportion of G~-bacteria and fungal infections increased.4.Both G~+and G-bacteria are highly resistant to penicillins and cephalosporins.G~+bacteria are more sensitive to aminoglycosides,peptides,lysines,rifampicin and quinupristin.G~-bacteria pairsβ-lactamase inhibitor complex,quinolones,cefoxitin are more sensitive,the drug susceptibility results are in line with the status of domestic bacterial resistance.