Clinical Analysis Of Neonatal Urinary Tract Infection

Objective : Through investigating into the clinical characteristics,pathogen distribution,drug sensitivity and therapeutic effect of neonatal Urinary Tract Infection(UTI),this thesis is an attempt to provide theoretical basis for clinical diagnosis and treatment of UTI.Methods:The research objects in this thesis include 44 neonates diagnosed with UTI in neonatal unit of Baoding Children's Hospital from January,2014 to October,2015.The diagnostic criteria are based upon the 4th edition of Practical Neonatology[1].Among those neonates concerned,there are 31 boys and 13 girls;38 full-term infants and 6 premature infants;7 early neonates and 37 late neonates;31 with exclusive breastfeeding and 13 with artificial feeding or the mixed way of feeding;one case with simple urinary infection and 33 cases with bilirubinemia;7 cases of pneumonia,6 cases of septicemia,5 cases of purulent meningitis,3 cases of blepharitis internus,one case of shock,septic disease,respiratory failure,hypoglycemia,anemia and impetigo respectively.Collection of specimens: After cleaning the vulva,sterile SNQ28 type infant urine collectors are pasted to collect samples for routine examination.When the urine WBC is over 5 / HP,aseptic catheterization is carried out to collect urine for culture and colony counting,and the drug sensitivity test is conducted as well.Statistical analysis: the SPSS19.0 software is used for statistical analysis,and the statistical methods include?~2 test or t test of Four Case table data.When P is less than 0.05,the difference is statistically significant.Results:1 The clinical manifestations of neonatal UTI are not typical,and the top three are fever,jaundice and mental weakness or sluggishness.It is often associated with other diseases,the most common of which are hyperbilirubinemia,pneumonia and sepsis.2 The male and female ratio rate of the 44 cases is 2.38:1.Boy incidence rate is 70.45%(31/44),significantly higher than that of the girls,29.55%(13/44).Both of them are statistically different.3 In 44 cases of neonatal UTI,the urine routine abnormal rate is 100%,the urine culture positive rate is 75%,and urinary tract ultrasound abnormal rate is 20%.4 In 33 urine culture positive neonates,gram-negative bacteria account for 57% while gram-positive bacteria account for 42%.The pathogenic bacteria are as follows: 10 cases of Escherichia coli,8 cases of enterococcus faecalis,6 cases of pneumonia Klebsiella,3 cases of Enterococcus faecium,2 cases of Enterobacter cloacae,one case of Staphylococcus aureus,Acinetobacter Bauman,Staphylococcus aureus and Staphylococcus aureus respectively.Escherichia coli and pneumonia Klebsiella are resistant to ampicillin and most of cephalosporin drugs,and the resistance rate is over 40%.They are 100% sensitive to piperacillin / tazobactam,imipenem and meropenem;Enterococcus faecalis is 12.5% resistant to ampicillin,ampicillin /sulbactam and penicillin.Enterococcus faecium is 100% resistant to ampicillin,ampicillin / sulbactam and penicillin.The enterococci are 100% resistant to erythromycin and vancomycin.Conclusion:1 The clinical manifestations of neonatal UTI show a lack of specificity,with systemic symptoms and less local urinary tract features.2 The neonatal UTI is mainly concerned with blood infection,often with systemic disease such as pneumonia and septicemia.Boys show a higher incidence rate.3 Neonatal UTI diagnosis is mainly based on detection of urine.For low-spirited newborns with unexplained fever,they should receive timely urine examination to avoid missed diagnosis or misdiagnosis.4 The pathogens of neonatal UTI are mainly gram-negative bacteria.The main pathogenic bacteria are Escherichia coli and Enterococcus faecalis,which are resistant to most of the penicillin and cephalosporin antibiotics.Therefore,clinicians should choose sensitive antibiotic treatment according to the drug sensitivity test results.