To identify differences in the clinical characteristics of early- and late-onset sepsis (EOS and LOS) caused by Klebsiella pneumoniae ( K. pneumoniae) and to describe the risk factors for multidrug-resistant K. pneumoniae (MDR-KP) infection. Infants with K. pneumoniae-induced sepsis who were admitted to a children’s Hospital between Jan 2000 and Dec 2019 were included. All infants were divided into EOS and LOS groups, as well as MDR-KP and non-MDR-KP groups. Demographics, clinical characteristics, and risk factors were compared between the two groups. One hundred eighty infants (66 with EOS and 114 with LOS) were further analyzed, accounting for 36.8% of sepsis cases caused by MDR-KP. The frequency of respiratory failure, bronchopulmonary dysplasia, and intraventricular hemorrhage were more common in the LOS group and a higher rate of acute respiratory distress syndrome was more common in infants in the EOS group ( P < 0.05). K. pneumoniae showed a low sensitivity to penicillin, beta-lactams and cephalosporins, and it showed a high sensitivity to levofloxacin, ciprofloxacin, and amikacin. Prematurity, low birth weight, longer antibiotic exposure time, long duration of peripheral catheter insertion, long mechanical ventilation time, and long parenteral nutrition time were associated with an increased rate of MDR-KP infection by univariate analysis ( P < 0.05). The regression analysis identified a long antibiotic exposure time (OR = 1.37, 95% CI: 1.01–1.89) and long parenteral nutrition time (OR = 1.39, 95% CI: 1.01–1.89) as independent risk factors for a MDR-KP infection, and a greater gestational age and birth weight were associated with a lower risk of MDR-KP infection (OR = 0.57, 95% CI: 0.40–0.79). LOS caused by K. pneumoniae may lead to a higher frequency of complications. The risk factors for MDR-KP infection were longer duration of antibiotic exposure and parenteral nutrition. A greater gestational age and larger birth weight may decrease the risk of MDR-KP infection.

PurposeTo identify risk factors associated with the development of acute respiratory distress syndrome (ARDS) in infants with early onset sepsis (EOS) and to describe the clinical features.MethodsA retrospective study was conducted at the Children’s Hospital of Chongqing Medical University between January 2000 and October 2020. The infants were divided into ARDS and non-ARDS groups. Clinical characteristics and risk factors were compared between the two groups.ResultsTwo hundred fifty infants (58 with ARDS) were included. Smaller gestational age, lower birth weight (LBW), lower serum albumin level, a higher rate of preterm birth, premature rupture of membranes, antenatal steroid exposure, and lower Apgar score were associated with an increased development of ARDS by univariate analysis (P &lt; 0.05). LBW (β = −0.001, P = 0.000, OR: 0.999, 95% CI: 0.998–0.999) and low serum albumin levels (β = −0.063, P = 0.022, OR: 0.939, 95% CI: 0.889–0.991) were identified as independent risk factors for the development of ARDS by logistic regression analysis. A higher frequency of complications, including persistent pulmonary hypertension, intraventricular hemorrhage, pulmonary hemorrhage, septic shock, and bronchopulmonary dysplasia, was found in the ARDS group (P &lt; 0.05). The rate of mortality was higher for those in the ARDS group than for those in the non-ARDS group (46.6% vs. 15.6%, χ2 = 24.205, P = 0.000).ConclusionAcute respiratory distress syndrome (ARDS) in EOS could lead to a higher frequency of complications and mortality. The risk factors for the development of ARDS were LBW and low serum albumin levels.

Purpose To develop and validate a multivariable predictive nomogram to diagnose neonatal bacterial meningitis (NBM).Methods A retrospective study was conducted and neonates with positive blood culture were included. Infants were divided into training and validation set. A predictive nomogram was established according to finding of univariate analysis and multivariate logistic regression. The diagnostic value was judged by receiver operating characteristic curves (ROC). ResultsAmong the 587 infants included finally, 177 of them developed NBM. Among training set (N=410), the incidence of abnormal temperature, seizure, bulging anterior fontanel were more common in NBM group (P<0.05). Higher of protein, WBC and lower glucose in cerebrospinal fluid (CSF) were found in NBM group (P<0.05). Bulging anterior fontanel, seizure, abnormal temperature, abnormal protein and WBC in CSF were considered as the independent predictors of NBM. A predictive nomogram was established, the C index was 0.89 and the sensitivity, specificity, positive predictive value, and negative predictive value were 63.4%, 94.3%, 83.3%, and 84.6% in internal validation.The model was validated in validation set (N=177). And the C index was 0.93, and the sensitivity, specificity, positive predictive value, and negative predictive value were 58.7%, 97.7%, 90.0%, and 87.1% in the validation set respectively in external validation. High score would increase the probability of NBM.ConclusionThe model including clinical manifestations had high potential diagnostic value in the prediction of NBM.