Abstract:

Objective To understand the clinical characteristics and pathogenic composition of non-elevated peripheral blood leukocytes in children with sepsis. Methods A retrospective analysis was performed in 84 children with sepsis who had non-elevated peripheral blood leukocytes hospitalized in Hebei Children's Hospital from 2013 to 2020. Children with only gram-positive bacteria were divided into gram-positive bacteria infection group(n=27) and children only with gram-negative bacteria were divided into gram-negative bacteria infection group(n=26). Furthermore, the clinical data in groups were compared. Results In 84 children, the age of onset was mainly from 0 to <1 year (47 cases, 55.9%). There were 81 cases (96.4%) with fever and 80 cases (95.2%) with abnormal mental state. The median of peripheral blood C-reactive protein and procalcitonin were 157.7 g/L and 12.66 μg/L, respectively.Respiratory system was the most common site of first infection (43 cases, 51.2%). Fifty-five cases (65.5%) were only detected with bacteria and 6 cases (7.1%) were only detected with viruses. Two cases (2.4%) were only detected with Mycoplasma pneumoniae, and a total of 21 cases (25.0%) were detected with multiple pathogens. Among them, the majority of the detected bacteria were multi-drug resistant bacteria. Thirty-seven cases (44.0%) were diagnosed with severe sepsis and septic shock; 58 cases were cured(69.0%). Compared with the gram-negative bacteria infection group, the gram-positive bacteria infection group had statistical differences in the terms of first infection, peripheral blood white blood cell count, neutrophil count, and neutrophil percentage (P<0.05). Conclusion Multi-drug resistant bacteria are the main infections for non-elevated peripheral blood leukocytes of sepsis. The age of onset was relatively small and the mortality rate was relatively high. First-onset infection site, peripheral blood leukocytes and neutrophil counts are used to preliminarily determine bacteria identification, and carry out early empirical treatment.

Key words: sepsis, children, pathogen composition