Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017

Abstract

Neonatal sepsis (NS) remains a major cause of morbidity and mortality in neonates, but data on the etiology and antibiotic susceptibility patterns of pathogens are limited. The aim of this study was to analyze the clinical characteristics, risk factors, and the antibiotic susceptibility patterns of pathogenic microbes associated with NS at a tertiary children's hospital in Shanghai, China. Episodes of blood culture-proven sepsis in the neonatal intensive care unit (NICU) of Children's Hospital of Fudan University from January 2013 to August 2017 were retrospectively reviewed. Collected data included demographics, perinatal risk factors, clinical symptoms, laboratory values, microbiology results and their antimicrobial susceptibility. Data for early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) were compared. The 341 of 976 culture-positive cases were selected, including 161 EONS cases (47.21% of 341) and 180 LONS cases (52.79% of 341). 635 incomplete cases were excluded. There was significant difference in risk factors between the EONS group and LONS group including birth weight, gestational age, 1-minute Apgar score, respiratory support, and the use of peripherally insertion central catheter (PICC). Clinical symptoms such as fever, feeding intolerance, abdominal distension, and neonatal jaundice, and laboratory results such as hemoglobin and lymphocyte counts also showed between-group differences. Staphylococcus epidermidis (22.87%) , Escherichia coli (9.68%), Alcaligenes xylosoxidans (9.38%) and Klebsiella pneumoniae (9.09%) remain the principal organisms responsible for neonatal sepsis. Most isolates of Gram-positive bacteria were sensitive to vancomycin, linezolid, minocycline and tigecycline, of which more than 90% were resistant to penicillin. Most isolates of Gram-negative bacteria were sensitive to amikacin and imipenem and resistant to ampicillin. Fungus was sensitive to antifungal agents. Better medical decisions, especially early detection and appropriate initial antimicrobial therapy can be made after understanding the different clinical features and pathogens of EONS and LONS.

Late-onset neonatal sepsis in Suzhou, China

“…In some regions from developing countries, CoNS have been reported to play a less important role [22,23]. In China, Guo et al found that CoNS was the third common organism responsible for LOS in South China [24], while Li et al found that CoNS was the most common organism in Southeast China [25]. The results in our study are in line with Guo's study.…”

Retrospective Analysis of Microbial Colonization Patterns in Central Venous Catheters, 2013–2017

“…Conversely, in 2016, the positive-cultured CVCs with staphylococci were primarily from the intensive care unit, and neonatal unit presented S. epidermidis predominantly. A study from China has displayed S. epidermidis was the principal organism and responsible for neonatal sepsis [33]. S. epidermidis is one of the common biofilm-producing bacteria affiliating colonization on indwelling or implanted foreign bodies [34].…”

Neonatal sepsis: within and beyond China

“…[ 72 , 73 ] As for Gram-positive bacteria, although resistance to glycopeptide including vancomycin and linezolid seem to be rare in China, methicillin resistance was reported for 60% to 70% of Staphylococcus spp. [ 37 , 38 , 40 ]…”