| Objective:To analyze the clinical characteristics of 312 cases of early-onset sepsis(EOS)and late-onset sepsis(LOS)in neonates in Dali,to identify neonatal sepsis(NOS)as early as possible,to reduce the prevalence and mortality of neonates,and to guide the clinical diagnosis and treatment of neonatal sepsis.Methods:Children admitted to the neonatal unit of the First Affiliated Hospital of Dali University from January 2013 to December 2020 and diagnosed with neonatal sepsis were analysed and could be divided into two groups according to their age of onset:early-onset and late-onset.Data conforming to a normal distribution are presented as mean±standard deviation(x±s);data not conforming to a normal distribution are presented as median and interquartile range[M(P25,P75)].Percentages(%)were used for statistical data and rank sum tests were used for differences between groups.Binary logistic regression analysis was used for multi-factor analysis,and the difference of P<0.05 was statistically significant..Results:1.Comparison of morbidity and general informationIn the past 8 years,the incidence of NOS in our hospital was slightly higher than the domestic average,and due to the special geographical location of our hospital,the incidence of NOS has shown an increasing trend year by year in recent years.312children with NOS,173 males and 139 females,the proportion of males was higher than that of females.103 males children in the EOS group(the ratio of males to females was about 1.2:1)and 70 males children in the LOS group(the ratio of males to females was about There was no statistical difference between the EOS and LOS groups in terms of gender,mode of delivery and TORCH infection(P>0.05);by comparing the gestational age and weight of the children in the two groups,it was found that there was a statistically significant difference between the EOS and LOS groups,but not in terms of gender.The proportion of low birth weight babies was higher in the LOS group than in the EOS group.The differences between the two groups were statistically significant(P<0.05)in terms of preterm birth,low birth weight,faecal contamination of amniotic fluid,deep vein placement,maternal chorioamnionitis,premature rupture of membranes>18 hours,maternal group B haemolytic streptococcal infection,and antenatal fever excluding chorioamnionitis.There was no statistical difference between the two groups in terms of asphyxia,maternal hypertension,maternal hyperglycaemia,premature rupture of the placenta and placenta previa(P>0.05);the mean birth weight in the EOS group was 3.29±0.57Kg and in the LOS group was 3.10±0.97Kg.In the EOS group,the mean The mean gestational age in the EOS group was 37.5±1.87w and in the LOS group was 37.1±2.10w.Analysis revealed statistically significant differences in birth weight and gestational age between the EOS and LOS groups(P<0.05).2.Comparison of clinical manifestations and local infections between the two groupsThe clinical manifestations of 312 children with NOS were statistically analyzed.Abnormal body temperature and poor response were the more common clinical manifestations of NOS,and there were statistical differences between the EOS and LOS groups in abnormal body temperature,poor response,pathological jaundice,apnea,irregular breathing and mechanical ventilation(P<0.05).There was no statistical difference between the EOS and LOS groups in the proportion of skin sclerosis,poor appetite,hepatosplenomegaly,petechiae of skin and mucous membrane,bruising and respiratory distress(P>0.05);local infections of each system in the EOS group were:110 cases of respiratory infections(The local infections in the EOS group were:respiratory infections in 110 cases(56.4%),neonatal umbiliculitis in 18 cases(9.2%),urinary tract infections in 17 cases(8.7%),skin mucosal infections(buttock infections,impetigo,etc.)in 19 cases(9.7%)and neonatal conjunctivitis in 8 cases(4.1%).16cases(13.7%),16 cases(13.7%)of skin mucosal infections(buttock infections,impetigo,etc.)and 8 cases(6.8%)of neonatal conjunctivitis.Among the local infections,the two groups mainly referred to respiratory infections and umbiliculitis,which had a high incidence,and a statistical difference was found in the comparison(P<0.05)3.Comparison of non-specific experimental indices between the two groupsThe laboratory results of 312 children with sepsis showed that leukocyte abnormalities and C-reactive protein were the more common clinical manifestations of NOS,and there were differences between the two groups in the proportion of WBC abnormalities,CRP abnormalities,PCT abnormalities and interleukin abnormalities(P<0.05),and the proportions of WBC abnormalities,CRP abnormalities and PCT abnormalities in the LOS group were 29.9%,25.6%and 59.8%,while the percentages of WBC abnormalities,CRP abnormalities and PCT abnormalities in the EOS group were 16.4%,12.8%and 47.2%,respectively,which were found to be statistically different between the two groups(P<0.05).Analysis revealed that the differences between the EOS and LOS groups in terms of decreased PLT counts,abnormal I/T ratios and abnormal FIB values were not statistically significant(P>0.05).4.Comparison of complications and deaths between the two groupsThe results of complications and deaths of 312 children with sepsis were counted,where complications included:pneumonia,gastrointestinal bleeding,intracranial bleeding,septic meningitis,neonatal necrotizing small intestinal colitis,infectious shock,disseminated intravascular coagulation,and death.Pneumonia,bacterial meningitis,infectious shock and DIC were the more common clinical complications.the proportion of gastrointestinal haemorrhage and intracranial haemorrhage was higher in the EOS group than in the LOS group,the proportion of bacterial meningitis and infectious shock was higher in the LOS group than in the EOS group,and the proportion of gastrointestinal haemorrhage and intracranial haemorrhage was 7.7%and8.7%respectively in the EOS group,significantly higher than the 1.7%and 2.6%in the LOS group The proportions of bacterial meningitis and infectious shock in the LOS group were 13.7%and 8.5%respectively,compared to 6.2%and 2.6%in the EOS group,and analysis revealed a statistical difference between the two groups(P<0.05).The incidence of pneumonia in the early-onset group was 87.7%higher than the incidence of pneumonia in the late-onset group,67.5%.There was no statistically significant difference between the two groups when comparing the proportion of necrotizing small bowel colitis,DIC and death in neonates(P>0.05).5.Comparison of clinical regression between the two groupsOf the 195 children with EOS,160(82.1%)improved,23(11.8%)improved and continued treatment,and 8(4.1%)died,while of the 117 children with LOS,79(67.5%)improved,32(27.4%)improved and continued treatment,and 6(5.1%)died.There was no statistical difference between the EOS and LOS groups in terms of clinical outcome(χ2=3.647,P=0.986,P>0.05).6.Analysis of blood culture results and drug sensitivity in both groups1.Among the 312 children diagnosed with sepsis,a total of 51 blood cultures were positive.Upon statistical analysis,these 51 strains included 36(11.5%)Gram-positive(G~+),14(4.7%)Gram-negative(G~-)and 1(0.3%)fungal.The most common pathogens were Staphylococcus epidermidis(5.1%)(16/312),followed by Escherichia coli 3.5%(11/312),Staphylococcus humanus 3.5%(11/312),Staphylococcus haemolyticus 1.6%(5/312),Micrococcus garciniae 0.3%(1/312),Enterococcus faecalis 0.3%(1/312),Enterobacter cloacae 0.3%(1/312),Klebsiella pneumoniae 0.3%(1/312).Streptococcus lactis-free 0.3%(1/312),Methicillin-resistant Staphylococcus epidermidis 0.3%(1/312),Bacillus minor 0.3%(1/312),Candida albicans 0.3%(1/312).2.Resistance analysis of G~+bacteria,mainly coagulase-negative staphylococci(CoNS):resistance to penicillin G was 100%in all cases,and resistance toβ-lactams,cephalosporins and macrolides was very high,exceeding 80%in all cases.One case of multi-drug resistant bacteria was detected,methicillin-resistant Staphylococcus epidermidis(MRSE).Resistance to antibiotics such as quinolones and aminoglycosides were all at a low level,but due to the specificity of neonates and the serious side effects of the drugs,the above drugs are prudent or even prohibited in paediatrics.Resistance to peptides and oxazolidinones etc.were all at 0%.3.Resistance analysis of 14 cases of major G~-bacteria showed that G~-had high resistance to the first and second generation cephalosporins,and in recent years,with the widespread use of third generation cephalosporins,G~-resistance to third generation cephalosporins was significantly higher.The sensitivity toβ-lactamase inhibitor compound,carbapenems,etc.is better,among which Escherichia coli is up to 90%or more resistant to ampicillin and tetracycline,and more than 70%resistant to cefuroxime and cefoxitin,and no resistance to cefoperazone sulbactam,imipenem,quinolones,etc.was found;while Klebsiella pneumoniae is not only resistant to cefazolin first-generation cephalosporins,second-generation cephalosporins,but also to ceftriaxone and other third generation cephalosporins and otherβ-lactam antibiotics with extremely high resistance,mostly more than 90%resistance and poor sensitivity,no strains resistant toβ-lactamase inhibitor complexes,carbapenems,etc.were found with good sensitivity;while the resistance analysis of Enterobacter cloacae showed complete resistance(100%)to piperacillin,tetracycline,cephalosporins first,second and third generation,etc.,no Resistance to fourth generation cephalosporins such as cefotaxime and cefepime was found,and no strains resistant to antibiotics such as penicillins and quinolones were found.4.One case of Candida albicans was detected and its drug sensitivity analysis showed that amphotericin B,mycoplasma,fluconazole,5-fluorocytosine and itraconazole were all sensitive and resistance was 0%.Conclusions:1.The incidence of NOS is significantly higher in male than in female infants.Maternal premature rupture of membranes>18 hours,amniotic fluid and stool contamination,maternal chorioamnionitis,and group B streptococcal infection are high-risk factors for EOS;while low birth weight infants,long-term tube placement operation,and skin and mucous membrane infection are high-risk factors for LOS.2.G~+bacteria(mainly CoNS)are the main etiology of NOS in our hospital.Escherichia coli and Klebsiella pneumoniae are more common among G~-bacteria in EOS,while Staphylococcus and opportunistic pathogenic bacteria are predominant in LOS.3.EOS pathogenic bacteria infection is mainly through maternal vaginal flora upward and placental vertical transmission of infection,while LOS pathogenic bacteria infection is mainly through community-acquired infection and nosocomial infection,regular testing of neonatal sepsis pathogenic bacteria and drug sensitivity has certain reference significance to reduce the incidence of neonatal sepsis and improve the prognosis in our region. |
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