Park Kyung-Hee, Park Su-Jung, Bae Mi-Hye, Jeong Seong-Hee, Jeong Mun-Hui, Lee Narae, Han Young-Mi, Byun Shin-Yun
Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Korea.
Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea.
J Clin Med. 2022 Jan 4;11(1):260. doi: 10.3390/jcm11010260.
nosocomial sepsis remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important, but it is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings and to help choose antibiotics, when sepsis was suspected in ELBW infants.
a retrospective study was conducted on preterm infants, born at less than 28 weeks of gestation, with a birth weight of less than 1000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected sepsis, after the first 72 h of life, were assessed. We classified them into four groups according to blood culture results (gram positive, gram negative, fungal, and negative culture groups) and compared them.
a total of 158 patients were included after using the exclusion criteria, with 45 (29%) in the gram positive group, 35 (22%) in the gram negative group, 27 (17%) in the fungal group, and 51 (32%) in the negative culture group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than other groups. White blood cell (WBC) counts were the highest in the gram negative group and the lowest in the fungal group. The mean platelet counts were the lowest in the fungal group. C-reactive protein (CRP) levels were the highest in the gram negative group, while glucose was the highest in the fungal group.
in conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms in the nosocomial sepsis of ELBW infants. Increased WBC and CRP were associated with gram negative infection, while decreased platelet and glucose level were associated with fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.
医院获得性败血症仍然是极低出生体重（ELBW）婴儿发病和死亡的重要原因。早期准确诊断非常重要，但由于致病微生物临床表现相似，诊断困难。我们试图找出致病微生物在临床和实验室检查结果上的差异，以帮助在怀疑ELBW婴儿发生败血症时选择抗生素。
对2009年1月至2019年12月期间出生孕周小于28周、出生体重小于1000g的早产儿进行回顾性研究。评估出生后72小时内疑似败血症的临床和实验室检查结果。根据血培养结果将其分为四组（革兰氏阳性、革兰氏阴性、真菌和血培养阴性组）并进行比较。
采用排除标准后，共纳入158例患者，革兰氏阳性组45例（29%），革兰氏阴性组35例（22%），真菌组27例（17%），血培养阴性组51例（32%）。平均孕周、出生体重和新生儿发病率无显著差异，但发病年龄在真菌组早于其他组。白细胞（WBC）计数在革兰氏阴性组最高，在真菌组最低。平均血小板计数在真菌组最低。C反应蛋白（CRP）水平在革兰氏阴性组最高，而血糖在真菌组最高。
总之，我们发现ELBW婴儿医院获得性败血症的致病微生物在实验室检查结果上存在一些差异。白细胞和CRP升高与革兰氏阴性感染有关，而血小板和血糖水平降低与真菌感染有关。这些数据可能有助于在怀疑败血症时选择经验性抗生素。
