Clinical Analysis Of Neonatal Late-Onset Sepsis

Objective:To study the clinical manifestations, risk factors, pathogenic bacteria distribution and drug resistance, and guide the early prevention and reasonable treatment of late-onset sepsis(LOS) in the neonates. Methods:241 neonates with LOS were retrospectively studied in the First Hospital of Jilin University from January 2013 to December 2015. 241 neonates that did not have sepsis were selected as controls to study the common high risk factors. We use SPSS17.0 and WHONET5.6 software to analyze and process data. Results:(1) The clinical manifestations of LOS were not typical, with the main manifestations of poor dynamic response(66.0%), abnormal skin color(59.8%), fever(57.3%), and feeding intolerance(42.7%).(2) Univariate analysis showed that gestational age(GA) less than or equal to 34 weeks(W), birth weight(BW) < 1500 g, timing of feedings more than or equal to 4 days(d), timing of noninvasive assisted ventilation more than or equal to 7d, peripherally inserted central catheter(PICC), tracheal intubation, CMV infection, respiratory distress syndrome(RDS), bronchopulmonary dysplasia(BPD) and necrotizing enterocolitis(NEC) were related to LOS(P < 0.05). Conditional Logistic regression analysis suggested that GA≤34W(odds ratio [OR] =1.75, 95%CI: 1.08-2.84), BW < 1500g(OR=2.79, 95%CI: 1.49-5.24), tracheal intubation(OR=1.98, 95%CI: 1.17-3.35), timing of noninvasive assisted ventilation more than or equal to 7d, PICC(OR=2.09, 95%CI: 1.10-3.98) and CMV infection(OR=12.28, 95%CI: 2.76-54.76) were independent risk factors for the incidence of LOS.(3) The rate of nosocomial and community acquired infection was 4.4:1. Klebsiella pneumoniae accounted for the largest proportion(21.2%), followed by Escherichia coli(12.3%), Staphylococcus aureus(8.1%), candida albicans(7.7%) and Staphylococcus epidermidis(6.5%). Gram-negative bacteria made up 34.9% of the total 260 pathogens, followed by gram-positive bacteria(31.2%) and fungi(11.2%). Klebsiella pneumoniae accounted for the largest proportion in gram-negative bacteria(26.2%). Coagulase-negative staphylococci accounted for the largest proportion in gram-positive bacteria(17.3%). Candida albicans accounted for the largest proportion in fungi(7.7%). Pathogens in 2013 accounted for 34.6%, among which 22.3% was gram-negative bacteria, 11.5% was gram-positive bacteria and 0.8% was fungi. Pathogens in 2014 accounted for 26.5%, among which 14.6% was gram-negative bacteria, 8.8% was gram-positive bacteria and 3.1% was fungi. Pathogens in 2015 accounted for 38.8%, among which 20.4% was gram-negative bacteria, 10.8% was gram-positive bacteria and 7.7% was fungi.(4) Klebsiella pneumoniae drug resistance rates of ampicillin/sulbactam, piperacillin, cefazolin, ceftriaxone and cefuroxime were more than 75%, and the rates of cefepime, ceftazidime and aztreonam were between 50% and 75%. Escherichia coli drug resistance rate of cefazolin was more than 75%, and the rate of chemitrim was between 50% and 75%. Both of the two pathogens drug resistance rates of amikacin, meropenem and imipenem were less than 10%. Staphylococcus aureus and Coagulase negative staphylococci drug resistance rates of penicillin G and erythromycin were more than 75%. Staphylococcus aureus drug resistance rate of chemitrim and tetracycline was between 50% and 75%. Coagulase negative staphylococci drug resistance rates of piperacillin/tazobactam, oxacillin, cefazolin, cefuroxime, cefotaxime and cefepime were more than 75%, and the rates of clindamycin, chemitrim, ciprofloxacin and levofloxacin were between 50% and 75%. Both of the two pathogens drug resistance rates of teicoplanin, vancomycin, linezolid and quinupristin/dafoe leptin were 0%. Fungus was sensitive to commonly used antifungal drugs. Conclusions:(1)The clinical manifestation of neonate LOS was not typical.(2)GA less than or equal to 34 W, BW less than 1500 g, tracheal intubation, timing of noninvasive assisted ventilation more than or equal to 7d, PICC and CMV infection were high risk factors for LOS.(3)The nosocomial infection was main infection of LOS, and majority of the pathogens were gram-negative bacteria. Klebsiella pneumoniae accounted for the largest proportion, followed by Escherichia coli, Staphylococcus aureus, candida albicans and Staphylococcus epidermidis. Fungal infection rate increased year by year.(4) The drug resistance of bacteria in our center is common, especially klebsiella pneumoniae and coagulase negative staphylococcus aureus. It is very important to trengthen the monitoring of drug resistance and reasonable application of antibacterial drugs.