| Objective:By analyzing the risk factors,clinical features,and pathogens of late-onset sepsis in very low birth weight infants and very premature infants in our hospital,provide guidance for early identification and intervention in the treatment of late-onset sepsis.Methods:A collection of very low birth weight infants and very premature infants admitted to the NICU of the First Affiliated Hospital of Kunming Medical University from January 1,2019 to December 31,2020,according to whether late-onset sepsis(LOS)occurs,it was divided into two groups:LOS group and control group.Using a case-control study to retrospective analyze the risk factors,such as gestational age,birth weight,newborn gender,whether tracheal intubation during resuscitation,PS treatment,body temperature and blood sugar at admission,mechanical ventilation time before LOS,non-invasive respiratory support time before LOS,umbilical vein catheterization time before LOS,PICC placement time before LOS,whether to place a stomach tube,first enteral feeding time,enteral feeding,intravenous nutrition time,establishing time for total enteral feeding,age when the calorie reaches 100 and 120kcal/kg.d,whether to use probiotics before LOS,whether antibiotic use is≥5d before LOS,whether suffer from early-onset sepsis,etc.complications,outcome,pathogens and other data in the LOS group.Using SPSS26.0 statistical software,single-factor analysis and multi-factor Logistic regression analysis were performed,and the incidence,mortality of LOS were analyzed.Results:1.188 cases of very low birth weight infants and very premature infants admitted to the NICU of the First Affiliated Hospital of Kunming Medical University from January 1,2019 to December 31,2020,the incidence rate of LOS was 34.0%(64/188),of which 32 cases were diagnosed by blood culture or cerebrospinal fluid culture,and the incidence rate was 17.0%(32/188),of which 32 cases were clinical diagnosed,the incidence rate was 17.0%(32/188).The incidence rate of LOS in gestational age<28w,28-31+6w,and≥32w were:42.9%(3/7),37.8%(51/135),21.7%(10/46);The incidence rate of LOS in birth weight<1000g,1000-1499g,≥1500g were:61.5%(8/13),35.0%(49/140),20.0%(7/35),the difference between the three groups was statistically significant(P<0.05).There were 64 cases with LOS 4 deaths,and case fatality rate was 6.3%(4/64).2.The gestational age,birth weight,non-invasive respiratory support time of LOS,and use of probiotics before LOS were lower than those in the control group,and the difference was statistically significant(P<0.05);In the LOS group,umbilical vein catheterization,umbilical vein catheterization time,PICC before LOS,PICC catheterization time,fasting time before LOS,age when the calorie reaches 100kcal/kg.d,age when the calorie reaches 120kcal/kg.d,establishing time for total enteral feeding were higher than those in the control group,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that very low birth weight infants and very premature infants with small gestational age,low birth weight had an increased risk of LOS(P<0.05),long time of non-invasive respiratory support before LOS,use of probiotics before LOS had a reduced risk of LOS(P<0.05).3.The clinical manifestations of LOS are mainly in 46 cases(71.9%)with poor response,34 cases(53.1%)with abdominal distension,and 30 cases(46.9%)with apnea,in the laboratory examination,46 cases(71.9%)increased in CRP,34 cases(53.1%)increased/decreased in the total number of white blood cells,and 27 cases(42.2%)increased in PCT;The incidence rate of NEC in LOS group was significantly different from that in control group(P<0.05).4.32 Cases of confirmed LOS were co-cultured in 41 cases of pathogenic bacteria,2 cases cultivated 3 different types of pathogenic bacteria,3 cases cultivated 2 different types of pathogenic bacteria,1 case had 2 LOS cultures and cultivated the same pathogen,1 case had blood culture,cerebrospinal fluid culture were both positive,and for the same pathogen,2 cases were negative for blood culture and positive for cerebrospinal fluid culture,The 41 pathogens are:21 cases of gram-negative bacteria,accounting for 51.22%of all pathogenic bacteria,including 13 cases of klebsiella pneumoniae,4 cases of escherichia coli,2 cases of enterobacter cloacae subspecies,1 case of citrobacter freunii,and 1 case of klebsiella pneumoniae.,extended spectrum β-lactamase bacteria(ESBL)of 14 cases were detected,drug-resistant strains accounted for 71.43%,of which pneumonia subspecies of Klebsiella pneumoniae was the most common.There were 18 cases of gram-positive bacteria,accounting for 43.90%of all pathogenic bacteria,including 7 cases of staphylococcus epidermidis,4 cases of staphylococcus capitalis,2 cases of enterococcus faecalis,2 cases of staphylococcus aureus,1 case of staphylococcus hemolyticus,1 case of enterococcus faecium,and 1 case of corynebacterium.2 cases of methicillin-resistant staphylococcus aureus(MRSA)were detected,12 cases of methicillin-resistant coagulase-negative staphylococci(MRSCNS)were detected,and staphylococcus epidermidis the most common.2 cases of fungi,accounting for 4.88%of all pathogenic bacteria,including 1 case of candida albicans and 1 case of candida near-smooth.Conclusion(s):1.The incidence rate of LOS in very low birth weight infants and very premature infants was 34.0%,of which the incidence rate of confirmed LOS was 17.0%,and the incidence rate of clinical diagnosis of LOS was 17.0%,the case fatality rate is 6.3%.Strengthening the comprehensive management of very low birth weight infants and very premature infants can reduce the incidence and fatality rate of LOS 2.Very low birth weight infants and very premature infants with small gestational age,low birth weight had an increased risk of LOS,long time of non-invasive respiratory support before LOS,use of probiotics can reduce risk of LOS.3.The clinical manifestations of LOS in very low birth weight infants and very premature infants are not specific,and the main manifestations are poor response,abdominal distension,and apnea,the combined application of CRP,WBC and PCT can improve the accuracy of LOS diagnosis,it will increase the risk of NEC.4.In our hospital,the main pathogens of LOS in very low birth weight and very premature infants were gram-negative bacteria,of which Klebsiella pneumoniae is the most common. |
