| Objective:Neonatal septicemia is a serious disease in the neonatal period,with atypical clinical manifestations and high mortality,so early identification and rational use of antibiotics are very important,but the types and drug resistance of pathogens are significantly different with regional distribution and time migration.In this paper,the data of neonatal septicemia in the Northwest Women and Children’s Hospital in the past 5 years were collected,and its characteristics were summarized in order to provide the basis for clinical diagnosis and treatment.Methods:The clinical data of 378 cases of neonatal septicemia diagnosed by Northwest Women’s and Children’s Hospital from January 1,2015 to December 31,collected and retrospectively analyzed.They were divided into early-onset and late-onset septicemia according to the time of onset,and were divided into premature and full-term septicemia according to gestational age.The general data,perinatal and hospitalized diagnosis and treatment data,clinical manifestations,laboratory examination,complications,etiological distribution,drug sensitivity and prognosis of different groups of children were counted and analyzed.Results:1.There were 378 cases of neonatal septicemia,of which 64 cases were diagnosed as septicemia and 314 cases were diagnosed as septicemia(positive blood culture).EOS was found in 132cases(34.9%),LOS)in 246cases(65.1%).There were 227 premature infants(60.1%)and 151 full-term infants(39.9%).The proportion of gestational age≥37 weeks and birth weight 2500g-3999g in EOS group was higher than that in LOS group,the roportion of 1000g-2499g infants with gestational age from 28 weeks to 36~+66 weeks and birth weight in LOS group was higher than that in EOS group,the onset age of premature infants was later than that of full-term infants,and the proportion of cesarean section was higher than that of full-term infants,and there was the statistical difference.2.The proportion of degree III amniotic fluid contamination and neonatal asphyxia in EOS group was higher than that in LOS group,the proportion of using ventilator and atheterization puncture before onset in LOS group was higher than that in EOS group,the proportion of premature rupture of membranes,gestational hypertension,using ventilator and catheterization puncture was higher than that in term group,and the proportion of mniotic fluid contamination in the full-term group was higher than that in the premature group,and there was the statistical difference.3.The proportion of jaundice and dyspnea in EOS group was higher than that in LOS group,fever,poor reaction,apnea,gray complexion and skin hair in LOS group were ore than those in EOS group,poor reaction,abdominal distension and vomiting,apnea,grayish complexion and skin blossom in the premature group were more than those in the full-term group,and fever and jaundice in the full-term group were more than those in the premature group,and there were statistical differences.4.The decrease of WBC,the decrease of PLT count and the increase of CRP in LOS group were more than those in EOS group,the decrease of WBC and PLT count in the remature group were more than those in the full-term group,and the increase of WBC in the full-term group was higher than that in the premature group,and there were statistical differences.5.There was more infectious pneumonia in the EOS group than in LOS group,and bacterial meningitis and NEC in the premature group were more than those in the full-term group,and there was the statistical difference.6.A total of 314 cases were positive in blood culture,and a total of 314 strains were cultured.Among them,there were 164 strains of G-bacteria(52.3%),126 strains of G+bacteria(40.1%),and 24 strains of fungi(7.6%).Among all the pathogens,the most mmon major pathogens were Klebsiella pneumoniae 67 strains(21.4%),CONS 65strains(20.7%),Escherichia coli 49 strains(15.6%),Listeria monocytogenes 17 strains(5.4%),Streptococcus agalactia 15 strains(4.8%)and Streptotrophomonas maltophilia 15strains(4.8%).Listeria monocytogenes and Escherichia coli showed an increasing trend,Streptococcus agalactia,Klebsiella pneumoniae and fungi showed a downward trend,and other major pathogens did not change significantly with the change of the year.The roportion of G+bacteria in EOS group was higher than that in LOS group,the roportion of G-bacteria and fungi in LOS group was higher than that in LOS group,the proportion of G-bacteria and fungi in the premature group was higher than that in term group,and the proportion of G+bacteria in term group was higher than that in the full-term group,and there were statistical differences.7.The CONS of the main G+bacteria was highly resistant to penicillin and erythromycin,oxacillin,sulfamethoxazole,cefoxitin,vancomycin,nitrofurantoin,linezolid,vancomycin,nitrofurantoin and linezolid.The resistance rate was more than 80%,oxacillin was more than 70%,cefoxitin was sensitive to cefoxitin,and was sensitive to vancomycin and linezolid.No resistant strains of Listeria monocytogenes to penicillin,sulfamethoxazole and ampicillin were found,and other drug sensitivity tests were not carried out.The resistance rate of GBS to erythromycin was about 70%.It was not resistant to penicillin linezolid.Staphylococcus aureus was 100%resistant to penicillin,about 75%resistant to erythromycin,about 40%resistant to oxacillin,and low resistant to cefoxitin,about 7%,and was completely sensitive to vancomycin and linezolid.Among G-bacteria,Klebsiella pneumonia and Escherichia coli were highly resistant to ampicillin,about 85%.It was highly sensitive to piperacillin-tazobactam and cefoperazone sulbactam,and the highest sensitive to imipenem and meropenem.Klebsiella pneumoniae is highly resistant to first-and second-generation cephalosporins,with a resistance rate of about 60%to fourth-generation cephalosporins and about 40%to third-generation cephalosporins.The resistance rate of Escherichia coli to the first and second generation cephalosporins is about 50%,and to the third and fourth generation cephalosporins is about 20%.Stenotrophomonas maltophilia was highly sensitive to meropenem and levofloxacin.Serratia marcescens and Klebsiella acidogenes were resistant to ampicillin and cefazolin,but sensitive to other antibiotics.Among the fungi,Candida glabrata was 40%resistant to fluconazole and 100%sensitive to other antifungal agents.Candida albicans and Candida albicans were not resistant to antibiotics.8.The hospitalization time of the LOS group was longer than that of the EOS group,and the hospitalization time of premature infants was higher than that of term infants,and the mortality rate was higher than that of term infants,and there were statistical differences.The case fatality rate of septicemia in our hospital in the past 5 years was9.8%.Conclusion:1.There were differences in perinatal diagnosis and treatment,clinical manifestations,laboratory examination,etiological distribution between EOS and LOS,premature termsepticemia.2.Most of the EOS showed dyspnea and jaundice.Premature infants with septicemia and LOS were prone to poor response,skin color.Febrile and jaundice were common in term infants with septicemia.3.The decrease of WBC and PLT count were common in septicemia and LOS of premature infants,and the increase of WBC was more common in term infants with septicemia.4.G-bacteria are the main pathogens in our hospital,G+bacteria are the most common pathogens in EOS and term septicemia,G-bacteria and fungi are more common in LOS and premature septicemia.5.Vancomycin and linezolid are the first choices for staphylococcal infection in our hospital.Penicillin and ampicillin are the first choices for Listeria monocytogenes infection.GBS infection can be treated with penicillin,linezolid.Ampicillin was not selected for G-bacteria infection,imipenem and meropenem were preferred for Klebsiella pneumoniae and Escherichia coli,piperacillin-tazobactam and cefoperazone sulbactam were selected. |
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