Clinical Research Of De-escalation Therapy Of Antimicrobial Agents On The Treatment Of Neonatal Severe Pneumonia

BackgroundNeonatal immune system and neonatal respiratory system acting as their barrier,are imperfect and immature,so Newborns are prone to lung infections,especially in premature infants and neonates with intubation and mechanical ventilation.Thus they are in the high-risk of lung bacterial infections,most of which are nosocomial infections,whose strains are mostly drug-resistant.Because the condition changes quickly,Therefore,a reasonable and effective use of antibiotics has become the key to successful treatment of Neonatal Severe Pneumonia.De-escalation Therapy is accepted as a effective strategy,which can balance “sufficient antibiotic treatment” and “antibiotic abuse”.A de-escalation strategy is therefore naturally advocated as one part of the better antibiotics usage.ObjectiveThrough retrospective data analysis in this dissertation,We aimed to investigate and assess the Clinical efficacy and safety from Clinical Research of De-escalation therapy of Antimicrobial Agents so as to Provide clinical evidence for the treatment of Neonatal Severe Pneumonia.MethodsFrom January 2011 to December 2015,A total of 168 cases of neonates with Neonatal Severe Pneumonia Hospitalized in Neonatal Intensive Care Unit(NICU),were divided into two groups according to treatment program,68 cases who accepted De-escalation Therapy group were Treatment group: Before Blood culture results were obtained in the laboratory,and which bacteria could not be confirmed.Take a "strike out" strategy by preferred use of broad-spectrum antibiotics,like Imipenem with cilastatin injection,15mg/kg,q6 h,lasting three to five days,Then according to blood culture results,namely sensitivity test results,Imipenem injection could be exchanged into sensitive antibiotics,or when in stable condition,we downgraded antibiotics to Mezlocillin or Cefoperazone until clinically cured.In the same period,the control group with 60 cases received routine therapy of antimicrobial agents,such as ceftriaxone,20~80mg/kg,qd,intravenouslly,Until symptoms disappeared or reaching discharge criteria.if cough still existed,pulmonary rales still existed,or did not decrease significantly for three to five days treaments,Antibiotics should be upgraded to the Sensitive,Carbapenems or antibiotic combination.Results1.Before the treatment,the two groups have no statistically significant difference in WBC and CRP(P>0.05),the treatment group decrease significantly than the control group after giving different treatment with statistically significance(P<0.05).2.The average time of temperature decreaing to the normal range observed during two groups,Treatment group spent(24.324±6.803)hours,the control group(46.050±10.743)hours.Comparing the two groups,significant difference was found(t=-13.464,P<0.001);3.In the aspect of Smooth breathing(R<40 beats/min),Inspiratory Three Depression Sign disappearance time of Two groups of patients,Observation group(49.221±7.586)hours,the control group(81.167±9.668)hours,Comparing the two groups,significant difference was found(t=-20.604,P<0.001).4.In terms of pulmonary rales disappeared time,Observation group was(73.750±7.302)hours,the control group was(121.683±9.349)hours,Comparing the two groups,significant difference was found(t=-32.020,P<0.001).5.As to time in stable condition,Observation group was(106.794±10.833)hours,the control group(146.183±14.236)hours,Comparing the two groups,significant difference was found(t=-17.731,P<0.001).6.In terms of Average hospitalization time of the two groups,Observation group spend(158.456±15.666)hours,being cured;the Average hospitalization time was(250.267±42.581)h,being cured.Comparing the two groups,significant difference was found(t=-15.785,P<0.001).7.Through statistical analysis between the treatment group(The De-escalation therapy group)and the control group(The conventional treatment group),The treatment group included 68 patients,40 cases accounting for 58.8 percent were markedly,effective in 26 cases with the percentage of 38.2%;invalid in 2case with the rate of 2.9%;The other 60 cases composed the control group,of which 25 cases were markedly,the percentage was 41.7;18 cases effective and 17 cases invalid accounting for 30.0% and 28.3% respectively.The two sets of data obtained by using chi-square test,De-escalation therapy group was significantly higher compared with the control group.the difference is significant(?2 = 16.259,P<0.001).8.Thrush occurred in 1 patient in the Treatment group,10 cases in the control group,the difference was statistically significant(?2 = 9.370,P = 0.002).ConclusionBefore clearing out pathogens,the application of de-escalation therapy for neonatal severe pneumonia is active and effective by shortening the hospitalized time and improving the success rate.