Clinical Analysis Of Single Center Neonatal Bloodstream Infection

Objective:Bloodstream infections are the common infectious disease,a serious threat to children’s physical and mental health,this topic retrospective study I center the clinical data of neonatal blood stream infections,analysis result in the risk factors of neonatal appear bloodstream infections,analyze the main pathogen of antibiotic resistance,for clinical reasonable select antibiotics,reduce neonatal blood complications caused by infection,It provides theoretical basis for reducing case fatality rate.Materials and Methods:From January 2015 to December 2019,125 neonates hospitalized with bloodstream infection in NICU of our center were collected.The basic clinical data of all children(gestational age,sex,birth weight,delivery method,age of onset,premature rupture of membrane,intrauterine distress,history of asphyxia,tracheal intubation,PICC,gestational hypertension,gestational diabetes,maternal age,number of births,PN support,and discharge time)were collected.To understand the composition of pathogenic bacteria of neonatal bloodstream infection in our hospital;The top five pathogenic bacteria with more neonatal bloodstream infection were divided into gram-positive bacteria group and gram-negative bacteria group according to different gram staining.Comparison of related items:(1)Analysis of clinical characteristics to determine the risk factors of neonatal bloodstream infection;(2)Blood routine related indicators: WBC count,NLR,PLR,PLT count;(3)CRP and PCT values;(4)The incidence of bacterial meningitis,infectious pneumonia,NEC and septic shock;(5)Treatment outcome;(6)Studies on resistance of main pathogenic bacteria to common antibiotics.Results:Composition of pathogenic bacteria of neonatal bloodstream infection in our center:Gram-positive bacteria accounted for 62.70%,gram-negative bacteria accounted for30.95%,fungi accounted for 6.35%;The top five most common pathogens were Streptococcus agalactiae,Staphylococcus haemolyticus,Staphylococcus epidermidis,Escherichia coli and Klebsiella pneumoniae.Analysis of clinical characteristics: the age of onset of gram-positive bacteria infection was shorter than gram-negative bacteria infection.Compared with gram-positive bacteria,gram-negative bacteria infected neonates had lower birth weight,higher rate of premature rupture of membranes,higher utilization rate of PICC and higher PN support rate,with statistical significance(P<0.05).The results showed that the blood WBC count and NLR value of gram-positive bacteria infection neonates were higher than those of gram-negative bacteria infection neonates.The number of serum PCT in neonates infected with Gram-negative bacteria was higher than that of neonates infected with gram-positive bacteria,and the difference was statistically significant(P<0.05).The incidence of complications: there was no significant difference in the incidence of complications caused by the five most common pathogens(P > 0.05).However,the occurrence of bacterial encephalitis is closely related to streptococcus agalactiae and Escherichia coli infection.The occurrence of infectious pneumonia is closely related to the infection of Streptococcus agalactiae,Staphylococcus epidermidis and Escherichia coli.Necrotizing enterocolitis is closely related to klebsiella pneumoniae infection.Septic shock is closely related to streptococcus agalactiae,Escherichia coli and Klebsiella pneumoniae infection.Treatment results: there were significant differences in cure rate and mortality between gram-positive and gram-negative infection neonates(P<0.05),among which the cure rate of staphylococcus epidermis infection neonates was the highest,and the mortality rate of streptococcus agalactiae neonates was the highest.Drug resistance analysis: Streptococcus agalactiae,Staphylococcus haemolyticus and Staphylococcus epidermis had higher drug resistance to erythromycin(51.21%),penicillin(60.98%)and oxacillin(56.09%)on the whole.Escherichia coli and Klebsiella pneumoniae had higher resistance to levofloxacin(30.76%),ciprofloxacin(26.92%),gentamicin(23.08%),ceftriaxone(34.62%)and ceftazidime(34.62%).Conclusions:Blood stream infection of newborns in our center was mainly caused by Gram-positive bacteria,followed by gram-negative bacteria.The first five pathogens were Streptococcus agalactiae,Staphylococcus haemolyticus,Staphylococcus epidermidis,Escherichia coli and Klebsiella pneumoniae.The age of onset of gram-positive bacteria infection in neonates was short;Gram-negative bacteria infected neonates had low birth weight,high incidence of premature rupture of membranes,high utilization rate of central venous catheterization through peripheral venipecture and high support rate of parenteral nutrition.Streptococcus agalactiae infection in the newborn body inflammation,complications,low cure rate,high mortality;The drug resistance of the five common pathogens is heterologous,so clinical characteristics,blood culture results and drug resistance should be fully combined in clinical practice to reduce neonatal mortality to the greatest extent.