Clinical Characteristics And Drug Resistance Of Premature Infants With Septicemia Caused By Different Pathogenic Bacteria

Objective1.To compare the clinical characteristics of septicemia in premature infants caused by Gram-positive bacteria(G~+),Gram-negative bacteria(G~-)and fungi.2.To explore the difference in the composition and distribution of the main pathogens of early-onset and late-onset premature septicemia.3.To compare the drug resistance of different pathogenic bacteria in premature infants with septicemia in order to provide evidence for clinical prevention and treatment of premature infants infection.Methods1.The clinical data of septicemia of premature infants admitted to the neonatal intensive care unit of our hospital from January 2014 to May 2018 were retrospectively analyzed.371 premature infants with positive blood culture were included in the study.The positive pathogenic bacteria first cultured during hospitalization were taken as the object of study,but no further study was made on the positive pathogenic bacteria cultured in follow-up blood culture.2.Analyze the composition and drug resistance of different pathogenic bacteria in premature infants with septicemia.3.Compare the clinical differences of septicemia caused by different pathogens.Results1.A total of 371 pathogens were detected,53 cases of G~+bacteria(14.3%),mainly include Staphylococcus epidermidis and Enterococcus;235 cases(63.3%)of G~-bacteria,mainly include Klebsiella pneumoniae and Escherichia coli;83 cases of fungi(22.4%),mainly include Candida albicans and Candida tropicalis.2.Gram-positive bacteria are more sensitive to vancomycin,Gram-negative bacteria are more sensitive to compound sulfamethoxazole,and fungi are more sensitive to flucytosine and amphotericin B.3.Klebsiella pneumoniae and Escherichia coli were the main pathogens of early-onset sepsis,and Klebsiella pneumoniae and Pseudomonas albicans were the main pathogens of late-onset sepsis.Klebsiella pneumoniae was the most common pathogen in premature infants with early and late-onset septicemia,but Klebsiella pneumoniae accounted for a higher proportion in the late-onset group(P<0.05).Escherichia coli and Streptococcus agalactiae accounted for a higher proportion in the early-onset group(P<0.05).4.There were no significant differences in gestational age,birth weight,sex,mode of delivery,premature rupture of membranes>18 hours,proportion of amniotic fluid III pollution and proportion of deep vein catheterization before infection(P>0.05).The onset age of G~-group and fungal group was later than that of G~+group,and the difference was statistically significant(P<0.05).The first symptoms were poor response in 140 cases,dyspnea in 123 cases,temporary respiratory arrest in 105 cases,fever in 24 cases and abdominal distension in 20 cases.The proportion of dyspnea in G~+group and G~-group was higher than that in fungal group,and the proportion of abdominal distension in fungal group was higher than that in G~+group and G~-group(P<0.05).There was no significant difference in poor response,apnea and fever among the three groups(P>0.05).5.In G~+group and G~-group,the number of white blood cells was higher than that of the fungal group,and the number of platelets in the fungal group was lower than that of the G~+group and G~-group(P<0.05),and there was no statistical significance in CRP count among the three groups(P>0.05).6.The turning negative time of blood culture in G~+group was shorter than that in G~-group and fungal group(P<0.05),and the time of mechanical ventilation before infection in G~-group was longer than that in G~+group and fungal group(P<0.05).The use of antibiotics before infection and the indwelling time of deep vein catheterization in fungal group were longer than those in G~+group and G~-group(P<0.05).7.The incidence of pneumonia and bronchopulmonary dysplasia in G~-group was higher than that in G~+group and fungal group,and the incidence of necrotizing enterocolitis in fungal group and G~-group was higher than that in G~+group(P<0.05).There was no significant difference in the incidence of meningitis,periventricular leukomalacia,Retinopathy,cholestasis syndrome and pulmonary hemorrhage among the three groups(P>0.05).Among all the patients,255 cases(68.7%)were cured,52cases(14.0%)were improved,64 cases(17.3%)were died and abandoned.Conclusions1.Gram-negative bacteria are the main pathogens causing septicemia of premature infants in neonatal intensive care unit(NICU)and have strong drug resistance.2.The clinical characteristics of septicemia in premature infants caused by different pathogenic bacteria were different.3.In order to reduce the mortality of premature infants,the drug resistance of pathogenic bacteria in blood culture should be comprehensively judged and treated according to the clinical characteristics.