Etiological Characteristics And Clinical Analysis Of 102 Neonatal Septicemia Patients With Positive Blood Culture

Objective:By investigating the clinical characteristics,treatment and clinical outcomes of neonatal septicemia patients who had been diagnosed by positive blood culture in NICU ward of our hospital in recent 7 years,as well as the distribution of pathogens and the transitions of antimicrobial resistance,the current situation of hospital acquired infection and multidrug resistant organisms,so as to provide evidence about rational use of antibiotics for clinical therapy.Methods:The clinical data,pathogens and antimicrobial susceptibility testing results of 102 neonatal septicemia patients with positive blood culture,who had been treated in NICU ward of our hospital from January 1,2015 to December 31,2021 were collected,They were divided into different groups for retrospective analysis,including early-onset sepsis(EOS)group and late-onset sepsis(LOS)group,full-term infants group and premature infants group,hospital acquired infection(HAI)group and multidrug resistance organisms(MDROs)group.Results:There were 64 neonates(62.7%)of EOS and 38 neonates(37.3%)of LOS;52 premature infants(51.0%),50 full-term infants(49.0%);12 neonates(11.8%)with HAI,90 neonates(88.2%)with non-HAI;25 neonates(24.5%)with MDROs,77 neonates(75.5%)with non-MDROs.5 neonates with MDROs of HAI origin,accounted for 20.0%;20 neonates with MDROs of nonHAI origin,accounted for 80.0%.In terms of maternal perinatal risk factors:The proportion of EOS group was significantly higher than that of Los group in the use of dexamethasone before delivery and the increased inflammatory indicators before delivery and maternal chorioamnionitis(P<0.05).Treatment during hospitalization:There were 75 cases were treated with total parenteral nutrition(73.5%),47 cases received Non-invasive ventilation(46.1%),38 cases received Endotracheal intubation(37.3%),38 cases were treated with central venous catheterization(37.3%),30 cases received mechanical ventilation(29.4%),The median types of antibiotics was 3.0(2.0,4.0),and the median duration of antibiotic treatment was 14.0 days(9.8,18.0).Clinical manifestation:The proportion of EOS group was significantly higher than that of Los group in abnormal blood glucose,feeding intolerance and apnea(P<0.05);the proportion of Los group was significantly higher than that in EOS group in low response or irritation,abnormal body temperature,protuberance of anterior fontanelle and diarrhea(P<0.05).Laboratory examination:The proportion of increased SAA and decreased PLT in Los group was significantly higher than that in EOS group(P<0.05).Clinical complications:The proportion of EOS group was significantly higher than that of LOS group in gastrointestinal bleeding,RDS and respiratory failure(P<0.05),while the proportion of LOS group was significantly higher than that of EOS group in purulent meningitis(P<0.05).Clinical outcomes:There were 94 neonates who had been cured or got better(92.1%),7 neonates had no been cured(6.9%)and 1 neonates died(1.0%)in total.There was no significant statistical difference between the EOS group and the LOS group(P<0.05).The proportion of positive blood culture septicemia(0.856%),HAI septicemia(0.101%)and MDROs septicemia(0.210%)was not high in NICU ward of our hospital in nearly 7 years.The proportion of positive blood culture septicemia showed a decreasing trend annualy from 2015 to 2018,and the proportion of HAI septicemia and MDROs septicemia also declined during this period。However,all of them surged to the highest in the year of 2019,and then showed a downward trend commonly.A total of 58 strain(56.9%)of Gram-positive(G+)bacteria,43 strain(42.1%)of Gram-negative(G-)bacteria,1 strain(1.0%)of fungi had been cultured.In general,the proportion of G+bacteria had increased annually in recent 7 years.The number of Streptococcus agalactiae(GBS),Escherichia coli and coagulase negative staphylococci occupied the top three.GBS accounted for the largest part of G+bacteria,while Escherichia coli accounted for the largest part of G-bacteria.GBS was predominant in EOS group and term infants group;Escherichia coli and CoNS were predominant in premature infants group,while EScherichia coli was predominant in LOS group.Klebsiella pneumoniae accounted for the largest proportion in HAI group.Staphylococcus epidermidis accounted for the largest proportion in MDROs group.The resistance rate of G+bacteria to antibiotics such as mezlocillin and penicillin was high,while the resistance rate of G-bacteria to various antibiotics was not high.Multidrug-resistant Staphylococcus epidermidis was completely resistant to penicillin;the resistance rate of multidrug-resistant Enterococcus faecalis to erythromycin,latamoxef and other antibiotics was as high as 80.0%;multidrug-resistant EScherichia coli was completely resistant to ampicillin and cotrimoxazole;multidrug-resistant Klebsiella pneumoniae was completely resistant to cefoperazone/sulbactam and cefixime.Conclusion:1、Newborns whose mothers received dexamethasone before delivery,had increased inflammatory indicators before delivery,and whose mothers had chorioamnitis were more likely to develop EOS.These were more common manifestations for the neonates with EOS,such as abnormal blood glucose,feeding intolerance and apnea;However,low response or irritation,abnormal body temperature,protuberance of anterior fontanelle and diarrhea were more commom for the neonates with LOS.These were more common complicatons for the neonates with EOS,such as gastrointestinal bleeding,RDS and respiratory failure;However,it was more likely to have suppurative meningitis for the neonates with LOS.2、The proportion of positive blood culture septicemia,HAI septicemia and MDROs septicemia was not high in NICU ward of our hospital in nearly 7 years.The proportion of positive blood culture septicemia showed a decreasing trend annualy from 2015 to 2018,and the proportion of HAI septicemia and MDROs septicemia also declined during this period。However,all of them surged to the highest in the year of 2019,and then showed a downward trend commonly.3、The EOS group of positive blood culture was mainly composed of G+bacteria in NICU ward of our hospital.GBS was predominant in EOS group and term infants group;Escherichia coli and CoNS were predominant in premature infants group,while EScherichia coli was predominant in LOS group.Klebsiella pneumoniae accounted for the largest proportion of pathogenic bacteria in HAI group.Staphylococcus epidermidis accounted for the largest proportion in MDROs group.4、The resistance rate of G+bacteria to antibiotics such as mezlocillin and penicillin was high,while the resistance rate of G-bacteria to various antibiotics was not high.It can provide basis for rational drug use in our institution by testing of neonatal sepsis pathogenic bacteria and drug sensitivity regularly.