Download Pathogens isolated in China

Neonatology:
Neonatal Septicemia
Lecture points
• Morbidity and mortality
• The compromised host of the
neonates in immunology
• Pathogens for clinical consideration
• Clinical manifestation
• Clinical Management
Incidence
• 1%～10%, in live birth
• 15-20%, in VLBW
Incidence
Gross incidence
‰
Comparison:
US and developing countries
‰
25
25
20
20
15
15
10
5
0
10
5
0
Neonatal Septicemia
Death rate: US
15%
12%
10.30%
9%
6%
5.30%
3.10%
3%
0%
USA
Preterm
Full
Neonatal Septicemia
Death rate：developing countries
8%
20%
15%
6%
10%
4%
5%
2%
0%
0%
death rate: 9.8%~12%
LONS 7.5%
Immunological features
in neonates
• Immature development in body defense
• Imperfect function
• Less experience of exposure to
environment and pathogens
• Affected by maternal antibodies
Immunological features
in Neonates
Non-specific Immune:
• Poor barriers function
• Undeveloped complement activation
capacity
• Relative fewer neutrophil, Immature
Function
• Lower ILs, lower level of cytokines
Immunological features
in Neonates
Specific Immune:
• Quantities and quality of Ig G, A, M
• T, B cell: quantities, quality and their function
Pathogens
• Domestic:
– Staphylococcus: most commonly seen
– Escherichia coli, etc.
– G- bacillus
• US:
– GBS: the leading pathogen during 1970’s
– Escherichia coli: the leading pathogen
during 1990’s
Pathogenic Changes
EONS: Changes by G+ vs. G‰
8
7
6
5
GBS
E.coli.
4
3
2
1
0
Early 1990’s
Late 1990’s
Pathogenic Changes
20%
any
G+
GGBS
E.coli
15%
10%
5%
0%
91-93
96-00
year
Relevant factors of pathogenic changes
• Change of colonized pathogens in maternal birth canal
• GBS Screening
• Preventive antibiotic therapy used during pre partum
•
Ampicilline for the mother with GBS positive :
pre partum and Intro-partum GBS Septicemia
Efficacy：around 70%（vs. control P < 0.0001）
Pathogens based on the types
in developed country
• EONS：
– E. coli
– Listeria
monocytogenes,
Pseudomonas
– Meningococcus
– Enterococcus and
GBS
• LONS：
– Coagulase-negative
Staphylococcus
– Haemophilus
influenza bacillus
– Other pathogens
Pathogens based on the types in
developed country
Others >8%
Staph 40%
GBS <10%
Klebsiella 15%
E.coli. 27%
Pathogens based on the types
in developing country

VEONS (within 24 hours after birth)
Klebsiella、E. coli、Enterococcus

EONS (within 24-48 hours after birth)
G+ = G G+：mainly Klebsiella pneumoniae and E. coli
G-：Enterococcus commonly seen

LONS (48 hours after birth)
Mainly: G+ Coagulase-negative Staphylococcus
Partly reported：Staphylococcus epidermidis, GBS
and E. coli
Pathogens based on the types
in developing country
LONS
7%
Others
11%
EONS
40%
VEONS
42%
Early onset dominant
Related with the maternal and the intro-partum high risk factors
Pathogens isolated in China
main isolates from blood culture bsed on the ages: n=671/458/1849
45
40
35
CNS
金葡菌
E.coli
肠杆菌
假单胞菌
30
25
20
15
10
5
0
0-3d(671)
4-7d(458)
8-28d(1849)
临床儿科杂志：2002-2浙江大学附属儿童医院资料
Pathogens isolated in China
Domestic data：main isolates: n=815
30
25
20
15
10
5
0
表葡
腐生葡
E.coli
中华儿科杂志01-6；重庆儿科医院资料
金葡菌
克雷伯
不动杆菌
Pathogens isolated in China
main isolates account for during different periods: n=436
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
G+
staph
Staphylococcus
epidermidis
other CNS
92-94
95-96
临床儿科杂志02-5：深圳市人民医院儿科资料
99-00
Pathogens isolated in China
main isolates account for during different periods: n=436
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
其它G不动杆菌
假单胞菌
克雷白杆菌
沙门氏菌
E.coli
HF
其它G+
链球菌
肠球菌
其它CNS
表葡菌
金葡菌
92-94
95-96
临床儿科杂志02-5：深圳市人民医院儿科资料
99-00
Pathogens isolated in China
main isolates account for during different periods: n=606/475
100.00%
肠杆菌
棒壮杆菌
Ecoli
芽胞杆菌
CNS
金葡菌
80.00%
60.00%
40.00%
20.00%
0.00%
1989-1991
1999-2001
临床儿科杂志：2002-2 哈尔滨儿童医院资料
The path of Infection

Path:
1. Intrauterine infection
2. Intro-partum infection
3. Post delivering infection
Risk factors of sepsis occurrence
• Maternal intro-partum fever (OR=4.1 CI=1.2-13.4)
• Repeated Vaginal examinations (OR=2.9 CI=1.1-8.0)
• Among GBS Sepsis, Dystocia and maternal fever
account for 49%
• Prolonged membrane rupture ≥18 hour（79%）
• Prematures and LBW
• Later onset sepsis: PDA, Long time of Intravascular
catheter, various of invasive procedure, BPD
Clinical manifestations
General：
– Anorexia
– Less Crying
– Fewer physical
activities
– Lower temperature
or fever
– Poor weighting gain
– Persistent Jaundice
Focal:
– Omphalitis
– Skin infection
– Blepharitis (eyes)
– Otitis media
– Paronychia (nails)
Clinical manifestations
Toxic:
–
–
–
–
–
Shock
Hepatosplenomegaly
Skin deposition point
Distension
Anemia
Complication:
–
–
–
–
Meningitis
Pneumonia
Peritonitis
Urinary Tract
Infection
– Scleredema
– DIC
– Toxic myocarditis
Laboratories and investigation aids
• Peripheral whole blood test
• Blood culture
• Others:
– CRP/ PCT
– Smear of WBC: check bacterial
– CSF
– Urine
• CXR
Clinical Management
Antibiotic therapy
• Selection based on the pathogen isolated
• Early, Adequate dose, IV
• Duration:
– 2 weeks for G+, 3 weeks for G-.
– Longer duration for meningitis and severe
Clinical Management
Supportive therapy
– Dehydration
– Correct metabolic acidosis
– Maintenance of electrolyte and Acid-base
balance
– Enough energy supply
– Keep warm
– Correct hypoxemia
– Immunological therapy: IVIG
Clinical Management
Complication treatment
– Shock
– DIC
– Scleredema
– Respiratory failure
– Conversion
– Jaundice
– Focal lesion
Thanks for listening
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