Clinical analysis of neonatal septicemia caused by Streptococcus agalactiae / 中国小儿急救医学

ABSTRACT

Objective:To explore the clinical characteristics, treatment and prognosis of neonatal septicemia caused by Streptococcus agalactiae.Methods:There were 29 cases of neonatal septicemia caused by Streptococcus agalactiae from January 2017 to December 2019 treated at Qingdao Women and Children′s Hospital.These cases were divided into the early-onset group (onset day of the patients ≤7 d) and late-onset group (onset day of the patients>7 d). Clinical data were collected for analysis.Results:The cases included in the current study accounted for 10.8% of all neonatal septicaemia during the same period.There were 23 cases born via vaginal delivery (79.3%) and 6 cases born by cesarean section (20.7%). Eighteen cases (62.1%) had early-onset (≤7 d) sepsis, and eleven cases (37.9%) had late-onset (>7 d) sepsis.The incidence of pneumonia was higher in the early-onset group compared with the late-onset group (83.3% vs.36.4%), while the incidence of purulent meningitis in early-onset group was lower than that in the late-onset group (33.3% vs.81.8%), and the length of hospital stay was shorter in early-onset group[(16.17±9.33)d vs.(36.73±27.43)d]. The differences between two groups were statistically significant (all P<0.05). Peripheral white blood cell counts elevated in 9 (31.0%) cases, and reduced in 15 (51.7%) cases.The levels of C-reactive protein increased in 18 (62.1%) cases, while the early value of procalcitonin increased in all cases.Drug sensitivity test showed that the sensitivity rates to erythromycin, clindamycin and tetracycline were 30.0%, 31.0%, and 24.1%, respectively.All strains were sensitive to penicillin G, ampicillin, vancomycin, linezolid and cefotaxime.A total of 28 cases were treated with two antibiotics.Twenty-two cases (75.9%) were cured, three cases (10.3%) were discharged after improvement, four cases (13.8%) died after abandoning treatment, and one case was left with neurological sequelae. Conclusion:Streptococcus agalactiae is one of the common pathogens of neonatal septicemia.Children with different onset time may have different complications.Decrease in white blood cell counts and elevation of procalcitonin are highly sensitive to neonatal septicaemia caused by Streptococcus agalactiae.Penicillin and/or cephalosporin antibiotics are the first choice in treatment, and the critically ill patients are treated with combination of two antibiotics.