The Analysis On Pathogens Antibiotic Resistanceof Neonatal Septicemia And Clinical Significance Of Cytokine And CD64in Infants

ObjectiveNeonatal septicemia is one kind of quite common critical neonatal diseasesusually with complications, one of the major causes of death in newborns. Thisdisease is usually caused by generalized toxoinfection.The Pathogenic Bacteriainvade the blood circulation of Neonates, growing and vegetating inside,producing toxin and causing generalized infection. We should pay the greatattention to give earliest diagnosis and take efficient and timely antibioticstreatment. The purposes of this research:1)are to give the clinical guides onreasonable use of antibiotics and decrease the occurrence of antibiotic resistancethrough the study and analysis to antibiotic resistance and the distribution of themain Pathogenic Bacteria of Neonatal septicemia occurred in local NICU duringthe period2010-2012.2) are to take early diagnosis to Neonatal Septicemia andprovide the experimental evidences for the potential critical Children Patients ofSepticemia based on the study of the clinical meaning and the level changes ofcell factor cytokine IL-6、IL-8、TNF-a and neutrophil CD64in the blood serumof the newborn patients.Methodology1. The author made a retrospective analysis of the cases of NeonatalSepticemia in NICU of the Maternal and Child Health Hospital of Laiwu City inShandong Province during the period of2010.1-2012.12and made a research thedistribution of Pathogenic Bacteria and the resistance of the relative bacteriaaccording to the test results of blood cultures and susceptibility test.The blood cultures were performed by automated microbiology analyzer and its Corollary Reagent, and the antifungal sensitivity was detected by theK-B drug sensitive slips method.2. Seventy-nive cases were chosen from the newborn patients, who were inthe hospital in NICU of Maternal and Child Health Hospital of Laiwu City inShandong Province during the period2012.3-2013.2. They were divided into3groups according to the composite factors of the Clinical Symptoms, physicalSigns and Laboratory Indexes.(1) Septicemia Group (25cases):1) confirmed Septicemia group(12cases),including4cases of premature infants and8cases of term infants, with bloodculture positive, existing high risk factors of infection during the disease history,existing one or more clinical infection symptoms or physical signs.2) Clinicaldiagnosis septicemia group(13cases), including5cases of premature infants and8cases of term infants, with blood culture negative, but also existing high riskfactors of infection during the disease history, and existing one or more clinicalinfection symptoms or physical signs, meanwhile with equal or beyond.(2) Common infection group(26cases), including8cases of prematureinfants and18cases of term infants. Blood culture negative, less than2items ofNon–specific work-up, existing high risk infection factors during the diseasehistory, and existing one or more clinical infection symptoms or physical signs.(3)Noninfective group(28cases), including9cases of premature infants and11cases of term infants, with blood culture negative, normal for Non–specificwork-up, and without clinical infection symptoms or physical signs. All of thegestational age, age in days, sex characters, birth weight and childbirth wayshad no significant difference among the infants of three groups(P>0.05%),which were comparable. The concentration of serum cytokinesTNF-a、 IL-6、 IL-8were detected by the method (ELISA),and neutrophil CD64were detected by Flow Cytometry. Meanwhile, the examines of white cell countin peripheral blood and plasma C-reactive protein etc. were performed.Results1. Reseach about the disease incidence, the distribution of Pathogenic andantibiotic resistance of Neonatal Septicemia during the named period in thelocal area of Laiwu.(1) Morbidity of Neonatal SepticemiaTotal1570infants were born in our clinical section during2010.1-2012.12, and73confirmed cases of Neonatal Septicemia, accounting for4.7%of the totalnewborns in hospital, including22cases NEOS, accounting for30.1%of theconfirmed cases of Neonatal Septicemia, and51cases NLOS, accounting for69.9%of the confirmed cases of neonatal septicemia.(2) The distribution results of Pathogens for NEOS and NLOSThe presentation of Pathogens of Neonatal early-onset septicemia wasmainly the infection of Gram-positive pathogens, including mainlyStaphylococcus auras (account for16.1%), another Staphylococcus epidermises,MRSA and Streptococcus agalactiae (account for9.1%), Gram-negativepathogens include mainly Escherichia coli(account for20.5%), Klebsiellapneumonia (account for9.1%) and Acinetobacter baumannii(account for4.3%).The presentation of Pathogens of NlOS was mainly the infection ofGram-negative pathogens, including mainly Klebsiella pneumonia (account for23.1%) another Escherichia coli (account for8.3%), pseudomonas aeruginosa（account for7.8%）,and Acinetobacter baumannii(account for4.2%).(3) The Analysis on the results of Pathogens antibiotic resistance ofNeonatal SepticemiaGram-positive pathogens usually have higher resistance rate to penicillin,oxazocilline and cephazoline， but without resistance to vancomycin andclindamycin; Gram-negative pathogens have higher resistance rate tocephazoline, ampicillin, the first-generation cephalosporin, thesecond-generation cephalosporin and the Third-generation cephalosporinwithout enzyme, but presenting light resistance rate to carbopenems andCefoperazone.2. The comparative study of the expression of neutrophil CD64and thelevel changes of IL-6IL-8,TNF-a in the infants with Septicemia.(1) There’s significant difference（P <0.05） for the level of serum IL-6IL-8,TNF-a and the presentation of CD64among the Septicemia Group priortreatment, Common Infection Group and Non-infective Group.(2) The Septicemia Group PT with higher level of IL-6IL-8, TNF-a andpresentation of neutrophil CD64, compared with Common Infection Group andNon-infective group. There’s significant difference（P <0.05）.(3) The Septicemia Group PT and Common Infection Group PT showed higher level of IL-6IL-8, TNF-a and neutrophil CD64, compared withpost-treatment with antibiotic for7days. The Septicemia Group presentedremarkable difference. There’s statistic significance（P <0.05）Conclusions1.Through the study of the main distribution of Pathogenic Bacteria and theantibiotic resistance of Neonatal Septicemia for the newborns in NICU duringthe period2010-2012in the local area, we found that Neonatal SepticemiaPathogens (especially for NLOS) mainly formed by conditioned pathogen,usually along with multi-antibiotic résistance, so according to the epidemiccharacteristics of the pathogens, to clinically use of antibiotics sensitive to thebacteria, meanwhile to perform blood cultures and susceptibility test, andcorresponding adjustment would be needed as per the detection results of thesusceptibility test and Pathogens, to choose antibiotics sensitive to the bacteriaand to decrease the occurrence of drug resistant bacterial.2. There’s significant difference for the level of serum IL-6IL-8,TNF-a andthe presentation of CD64among the Septicemia Group prior treatment, CommonInfection Group and Non-infective Group. The findings provide an ideal indexfor early diagnosis of neonatal septicemia, and provide experimental basis forhigh-risk infants with suspected sepsis.