Comparative Analysis Of Clinical Factors Related To Early-onset And Late-onset Sepsis In Neonates

Objective:To provide a reference basis for early clinical diagnosis and treatment by comparing the differences in clinical factors,pathogenic distribution and drug resistance between early-onset sepsis(EOS)and late-onset sepsis(LOS)in newborns.Method:In this study,139 children admitted to the neonatal intensive care unit of our hospital and laboratory diagnosed with neonatal sepsis between January 2021 and December 2021 were collected as study subjects.They were divided into EOS group and LOS group according to their age at onset.The general conditions,perinatal factors,maternal and pregnancy history,risk factors,clinical manifestations,laboratory tests,complications,pathogenic bacteria distribution and drug resistance and other clinical data were collected,and the results of the two groups were statistically analyzed.Results:1.A total of 139 patients with neonatal sepsis were finally included in this study,including 46(33.1%)cases in the EOS group and 93(66.9%)cases in the LOS group.Compared with the EOS group,the newborns in LOS had younger gestational age,lower birth weight,and lower Apgar score,with statistically significant differences between the two groups(p<0.001).Compared with the LOS group,premature rupture of membranes(p<0.001)and fecal contamination of amniotic fluid(p = 0.013)were more frequent in EOS,and the difference between the two groups was statistically significant.The EOS group had a higher proportion of mothers with prenatal infections,while the LOS group had a higher proportion of mothers with gestational hypertension and prenatal glucocorticoid use,with statistically significant differences(p<0.05).In terms of susceptibility factors during hospitalization,the LOS group had a higher proportion of history of mechanical ventilation,pre-infection antibiotic exposure,peripherally inserted central catheter(PICC),blood transfusion,and total parenteral nutrition(TPN),and the difference between the two groups was statistically significant(p<0.05).2.In terms of clinical manifestations,skin pattern and apnea were more likely to occur in the LOS group,while tachypnea and convulsions were more likely to occur in the EOS group,with statistically significant differences between the two groups(p<0.05).3.In laboratory tests,platelet distribution width(p<0.001)and platelet count(p=0.037)were higher in the LOS group than in the EOS group,and hemoglobin was lower in the LOS group than in the EOS group(p=0.001),and the difference between the two groups was statistically significant.In blood gas analysis,lactate and base residual values were higher in the EOS group than in the LOS group,and the difference between the two groups was statistically significant(p<0.001)4.In terms of pathogenic distribution,the EOS group was dominated by Gram-negative bacteria(53.2%),among which Escherichia coli(19.1%)accounted for the most,the LOS group was dominated by Gram-positive bacteria(58.5%),among which Staphylococcus epidermidis(34.0%)accounted for the most,and there was no statistical difference between the two groups(p>0.05).The percentage of E.coli was higher in the EOS group,while the percentage of Epidermid Staphylococci were higher in the LOS group,and the differences were statistically significant between both groups(p<0.05).In this study,we analyzed the drug resistance of Staphylococcus epidermidis and Escherichia coli in both groups.The susceptibility of Staphylococcus epidermidis in the EOS group to tigecycline,vancomycin,linezolid,teicoplanin,daptomycin,moxifloxacin,rifampin,and gentamicin weas 100.0%,the resistance to penicillin was 100.0%,and the resistance to benzathine,erythromycin,and clindamycin was greater than 50.0%.Staphylococcus epidermidis in the LOS group had 100.0% susceptibility to tigecycline,vancomycin,linezolid,daptomycin,and rifampicin,100.0% resistance to penicillin,greater than 50.0% resistance to benzathine,erythromycin,and clindamycin,and less than 50.0% resistance to teicoplanin,levofloxacin,moxifloxacin,cotrimoxazole,and gentamicin.The difference between the two groups was not statistically significant(p > 0.05).E.coli in the EOS group was 100.0% sensitive to piperacillin/tazobactam,imipenem,and amikacin,more than 50.0% resistant to ceftriaxone and levofloxacin,and less than50% resistant to cefuroxime,ceftazidime,cefepime,and cotrimoxazole.The sensitivity rate of E.coli to piperacillin/tazobactam and imipenem in the LOS group was 100%,and the resistance rate to the remaining antibiotics was less than 50%,and the difference between the two groups was not statistically significant(p > 0.05).5.In terms of complications,20 cases in the EOS group developed complications(43.5%),which was higher than 25 cases in the LOS group(26.9%),and the difference between the two groups was statistically significant(p < 0.05).Compared with LOS,the EOS group had a higher proportion of septic meningitis and respiratory complications,and the difference between the two groups was statistically significant(p < 0.05).Further comparison of complications for the E.coli sepsis EOS group with the LOS group revealed that there were 7 cases(77.8%)of combined complications in the EOS group than in the LOS group with 3 cases(42.9%),but the difference between the two groups was not statistically significant(p > 0.05).Comparison of complications between the EOS and LOS groups for Staphylococcus epidermidis sepsis revealed that one case in the EOS group had complications(16.7%)and four case in the LOS group had complications(12.5%),with no statistically significant differences between the two groups(p > 0.05).Conclusions:1.Premature rupture of membranes,fecal contamination of amniotic fluid and maternal prenatal infection are risk factors for EOS,while mechanical ventilation history,pre-infection antibiotic exposure,and PICC are risk factors for LOS.2.Skin pattern and apnea were more likely to occur in LOS,while rapid breathing,respiratory complications,seizures and bacterial meningitis were more likely to occur in LOS.3.Gram-negative bacteria accounted for the largest proportion of EOS,with Escherichia coli taking the lead,and Gram-positive bacteria accounted for the largest proportion of LOS,with Staphylococcus epidermidis taking the lead,with no statistically significant difference between the two pathogenic drug sensitivity tests in EOS and LOS.