Clinical Comparative Analysis Of Bacterial And Fungal Late-Onset Sepsis In Very Low/Extremdy Low Birth Weight Infants

Objective:To analyze and compare the clinical features,pathogens,and prognosis of bacterial and fungal late-onset sepsis in very low/extremely low birth weight infants,and provide evidence for the early diagnosis,treatment and improvement of prognosis of late-onset sepsis in very low/extremely low birth weight infants.Methods:The clinical data of infants with very low/extremely low birth weight late-onset sepsis who delivered in the First Affiliated Hospital of Anhui Medical University from July 2015 to June 2020 was collected.According to the results of blood culture,they were divided into the bacterial group and the fungal group.Retrospectively analyzed the incidence,mortality,and pathogenic bacteria of late-onset sepsis in very low/extremely low birth weight infants,and compared the clinical manifestations and prognosis of the two groups.Results:During the study period,1115 very low/extremely low birth weight infants were treated in our hospital.62 cases had blood culture positive,including 11 cases died.The incidence of blood culture positive late-onset sepsis in very low/extremely low birth weight infants was 5.56%,the fatality rate was 17.74%.there were 37 cases in the bacterial group,and 25 cases in fungal group.The most common pathogen in the bacterial group was Klebsiella pneumoniae(12 strains,19.35%of all pathogenic bacteria),and the fungal group was Candida glabrata(11 strains,17.74%of all pathogenic bacteria).The proportions of apnea,abdominal distention/vomiting/retention,spleen enlargement and platelet<100×10~9/L in the fungal group were 32%,84%,20%and 48%,and those in the bacterial group were 8.11%,59.46%,2.7%and 21.62%.The fungal group was higher than the bacterial group,and the difference was statistically significant(P<0.05).The rate of heart rate increase in bacterial group was 40.54%,the median value of C-reactive protein(CRP)was 13.38mg/L,and the median value of procalcitonin(PCT)was 6.75ng/m L,which were higher than those in fungal group:4%,5.76mg/L,0.99ng/m L(P<0.05).13.51%of the bacterial group had central nervous system infections,and 40.00%of the fungal group had central nervous system infections.The fungal group was higher than the bacterial group,and the difference was statistically significant(P<0.05).Conclusion:Very low/extremely low birth weight infants have a high fatality rate of LOS.Increased heart rate,CRP and PCT increase indicate bacterial infection,apnea,abdominal distension/vomiting/retention,spleen enlargement,and platelets decrease is more indicative of fungal infection.Infants with fungal infection are more likely to have central nervous system infections than bacterial infections.It is necessary to actively check the lumbar puncture examination of cerebrospinal fluid in the occurrence of infection,reasonable adjustment of antibiotics.