Clinical Analysis Of 20 Cases Of Sepsis With Positive Blood Culture In Children

Objective To analysis the clinical features,etiology,laboratory examination,treatment and prognosis of sepsis in children,provide the basis for early diagnosis and treatment..Methods A retrospective study was performed on 20 cases with sepsis hospitalized in the second Department of Pediatrics,the First Affiliated Hospital of Guangxi Medical University from Jan 2012 to Dec 2016.Results 1.General information: sepsis more common in infants.this group of children <2 years of age accounted for 85% of the total,combined with basic disease accounted for 80%,the overall average hospitalization costs11143.00 [4987.98,23858.75] yuan.2.Clinical data: Overall,community-acquired sepsis-related sepsis accounted for 25%(5/20),hospital-acquired infection-related sepsis accounted for 75%(15/20).The G-bacteria infection group was mainly in summer and autumn,accounting for 83.33%,G+bacteria infection occurred in winter and spring accounted for 62.5%.Sepsis clinical manifestations of non-specific,often accompanied by fever,easy to merge multiple parts of the infection,commoninfection site followed by the respiratory system,digestive system,skin and soft tissue;all children have varying degrees of complications.3.Laboratory indicators: There was no significant difference between G-group and G+group with white blood cell count,platelet count,C-reactive protein,total bilirubin,albumin,creatinine,urea,activated partial thromboplastin time,plasma prothrombin time,electrolyte.4.Blood culture and drug sensitivity: bacterial distribution to Gram-negative bacteria infection dominated(60%,12/20),G-bacteria on cefazolin,ampicillin(sulbactam),nitrofurantoin,amoxicillin,Ceftazidime,cefoxitin,cephalosporin,cotrimoxazole and other drug resistance rate of more than 50%,gentamicin,ceftazidime,cefoperazone sulbactam,piperacillin tazobactam,imipenem,beauty Luomannan resistant to 22.2% or less,not detected on amikacin,polymyxin B,optapride resistant strains.Multiple drug-resistant bacteria detection rate is high(50%,10/20),Two strains of ESBLs and one ESBLs(-)multidrug resistance(MDRO)were detected in 5 Escherichia coli.In gram-positive bacteria,staphylococcus most common,100% resistant to oxacillin,erythromycin,clindamycin and cefoxitin,resistant to penicillin more than 80%,no vancomycin-resistant strains were detected.5.Antibiotic use: the group of cases of bacterial culture and drug sensitivity before the results were positive empirical anti-infection treatment,80%(16/20)of children using antibiotics in line with drug sensitivity,use combination therapy,third-generation cephalosporins,Semi-synthetic Pseudomonas aeruginosa penicillins mainly.Drug sensitivity results came out,sensitive and combined drug use(8 cases)according to the results of drug sensitivity adjusted to antibiotic monotherapy,drug resistance(4 cases)according to drug sensitivity adjustment of the use of sensitive antibiotics.Overall good results.6.Prognosis: 19 patients in this group cured or improved discharge,only 1case(Burkholderia cepacia infection sepsis)disease progression of respiratory failure,give up treatment discharged.Conclusion 1.sepsis can occur at all ages,most often occur in infants and young children within 2 years of age,mostly associated with underlying diseases.2.The clinical manifestations of sepsis are diverse,often accompanied by fever,easy to involve multiple parts,the most common primary infection is the lungs.3.Routine laboratory tests can not distinguish between the type of bacterial infection,antibiotic guidance is still dependent on the use of bacterial culture results.4.This group of patients with sepsis bacterial infection to G-bacteria common,mainly for Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa.G+bacteria to staphylococcus mainly.Multiple drug-resistant strains are common,clinical attention should be paid to the above-mentioned bacteria infection.