Pathogens Distribution and Antimicrobial Resistance in Bloodstream Infections in Twenty-Five Neonatal Intensive Care Units in China, 2017-2019

Abstract

BackgroundOvercrowding, abuse of antibiotics and increase of antimicrobial resistance negatively affect neonatal survival rates in developing countries. We aimed to define pathogens and their antimicrobial resistance (AMR) of early-onset sepsis (EOS), hospital-acquired late-onset sepsis (HALOS) and community-acquired late-onset sepsis (CALOS) in 25 neonatal intensive care units (NICUs) in China.Study designThis retrospective descriptive study included pathogens and their AMR from all neonates with bloodstream infections (BSIs) admitted to 25 tertiary hospitals in China from January 1, 2017, and December 31, 2019. We defined EOS as the occurrence of BSI at or before 72 hours of life and late-onset sepsis (LOS) if BSI occurred after 72 hours of life. LOS were classified as CALOS if occurrence of BSI was ≤ 48 hours after admission, and HALOS, if occurrence was > 48 hours after admission.Results1092 pathogens of BSIs collected from 25 NICUs including 349 EOS isolates, 702 HALOS isolates and 41 CALOS isolates. Gram-negative bacteria (GNB) dominated in EOS (56.7%) and HALOS (62.2%). The most frequent pathogens causing EOS were Escherichia coli (27.2%) and group B streptococcus (GBS; 14.6%) whereas in CALOS they were GBS (46.3%) and Staphylococcus aureus (41.5%). Klebsiella pneumonia (27.9%), Escherichia coli (15.7%) and fungi (12.8%) were the top three isolates in HALOS. Third-generation cephalosporin resistance rates in GNB ranged from 9.7–55.6% in EOS and 26–63.3% in HALOS. Carbapenem resistance rates in GNB ranged from 2.7–31.3% in HALOS and only six isolates in EOS were carbapenem resistant. High rates of multidrug resistance were observed in Klebsiella pneumonia (60.7%) in HALOS and in Escherichia coli (44.4%) in EOS. All gram-positive bacteria were susceptible to vancomycin except for three Enterococcus faecalis in HALOS. The adverse outcome rates in HALOS were high, ranging from 4.6–16.2%.ConclusionsEscherichia coli, Klebsiella pneumonia and GBS were the leading pathogens in EOS, HALOS and CALOS, respectively. The high proportion of pathogens, high degree of antimicrobial resistance and high proportion of adverse outcomes in HALOS underscore understanding of the pathogenesis and devise effective interventions in developing countries.