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Background:
This study aimed to describe the causative organisms of neonatal late-onset sepsis (LOS) and their antimicrobial resistance in Suzhou, Southeast China over a 7-year period.
Methods:
We performed a retrospective study on neonates with LOS from Jan1, 2011 to Dec 31, 2017. The demographic, clinical, and laboratory data of neonates with...
Context in source publication
Context 1
... died; E. coli was responsible for nearly one-third (11/34, 32.4%) of deaths and CoNS responsible for 17.6% (6/34). The proportion of infants with birth weight < 1500 g was larger among infants who died compared to infants who survived (64.7% vs 15.5%, p < 0.001) as was the proportion born at gestational age < 32 weeks (55.9% vs 22.6%, p < 0.001) (Table 4). Respiratory distress, neonatal jaundice, and convulsions were also more frequently experienced by infants who died. ...Similar publications
Members of the bacterial genus Cedecea cause acute infections worldwide in compromised hosts with serious underlying medical conditions. While global reports of Cedecea infections remain sporadic in the medical literature, cases of multidrug-resistant clinical isolates have been documented each year over the past decade, warranting a comprehensive...
Citations
... The decline in EOS may contribute to the escalation in the proportion of LOS. Furthermore, prominent risk factors for LOS include premature birth and need for intensive medical interventions such as intubation, mechanical ventilation, central catheter insertion, poor nutrition, and surgical procedures due to LBW (Pan et al., 2020;Kostlin-Gille et al., 2021). Some studies show a decrease in the premature birth rate of newborns during the COVID-19 period (Been et al., 2020;Bian et al., 2021), while conversely, other studies indicate that during the COVID-19 pandemic, the rates of premature births and low birth weight have increased (Charles et al., 2023;Gholami et al., 2023). ...
Objective
To assess the effects of COVID-19 pandemic on the epidemiology of neonatal sepsis and the antibiotic resistance profiles of pathogens involved.
Methods
This retrospective cohort study analyzed infants diagnosed with culture-proven sepsis at the neonatal department of a tertiary children’s hospital in East China from January 2016 to December 2022. We compared the clinical and microbiological characteristics of neonatal sepsis cases between the pre-pandemic Phase I (2016–2019) and during the COVID-19 pandemic Phase II (2020–2022).
Results
A total of 507 infants with 525 sepsis episodes were included, with 343 episodes in Phase I and 182 in Phase II. The incidence of early-onset sepsis (EOS) was significantly lower during Phase II (p < 0.05). Infants in Phase II had lower gestational ages and birth weights compared to Phase I. Clinical signs such as mottled skin, severe anemia, thrombocytopenia were more prevalent in Phase II, alongside a higher incidence of complications. Notably, necrotizing enterocolitis (NEC) (p < 0.05) and meningitis (p < 0.1) occurred more frequently during Phase II. Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) were the predominant pathogens isolated from infants of death and cases with complications. A significant decrease in the proportion of K. pneumoniae was observed in Phase II, alongside increased antibiotic resistance in both E. coli and K. pneumoniae. The period of the COVID-19 pandemic (Phase II) was identified as an independent risk factor for complications in infants with neonatal sepsis.
Conclusion
COVID-19 pandemic response measures correlated with a decrease in EOS and an increase in neonatal sepsis complications and antibiotic resistance.
... En China se identificó como principal factor de riesgo a las infecciones asociadas a los cuidados de pacientes neonatales siendo el patógenos más frecuentes la Escherichia coli, y los síntomas clínicos fueron el peso al nacer muy bajo, dificultad respiratoria y las convulsiones, para un diagnóstico es un cultivo bacteriano (Pan et al., 2020). ...
La sepsis neonatal es una infección de la sangre que se presenta a partir de los 90 días de nacido. El objetivo de esta investigación fue describir los factores de riesgo, sintomatologías clínicas y marcadores diagnósticos de la sepsis neonatal. El diseño metodológico fue documental con un tipo de estudio exploratorio, por medio de una revisión bibliográfica entre los años 2016 a 2023, se usó como estrategia de búsqueda las bases de datos de: National Center For Biotechnology Information, SCIELO, PLOS ONE, Dialnet, Frontiers, Parto F Springer Nature, MEDISAN, Springer link, Taylor y Francis Online. Los resultados de los estudios se enfatizaron que los factores de riesgo para una sepsis neonatal son las infecciones del tracto urinario de las mujeres embarazadas predominando las infecciones por bacterias como Estreptococos del grupo B y, otro factor es la ventilación mecánica. Los síntomas clínicos son dificultades respiratorias y fiebre mayor de 37 grados. Los Marcadores diagnósticos oportunos de sepsis neonatal son la Proteína C reactiva y a la biometría hemática, otros marcadores son los niveles procalcitonina y citocinas. Además, la prueba para la detección específica es un hemocultivo para el reconocimiento de la infección bacteriana. Concluyendo que la sepsis del recién nacido es una problemática de la salud donde existen varios factores para la aparición de la enfermedad, por otro lado, la descripción de esta patología como la sintomatología clínica y los marcadores de laboratorio es un aporte para un diagnóstico rápido y oportuno para un tratamiento seguro.
... In this study, the incidence and prevalence of early and late-onset neonatal sepsis in China showed an increasing trend from 1990 to 2019 compared to the USA, which is consistent with the report by Tao Pan et al. [20]. Meanwhile, there has been a decreasing trend in DALYs of neonatal sepsis in both China and the USA and a sustained decline in DALYs due to short gestation and low birthweight in China, which may be related to the better management of risk factors for neonatal sepsis. ...
Background: Neonatal sepsis has high morbidity and mortality, and there are differences between developing and developed countries in terms of its risk factors and disease burden. However, no systematic comparative analysis of this disease burden has been reported in recent years.
Methods: Using the Global Burden of Disease Study (GBD) 2019 as a data source, we assessed the prevalence, incidence, and disability-adjusted life years (DALYs) of early and late-onset neonatal sepsis in China and the United States of America (USA). We also analyzed DALYs rates due to short gestation and low birthweight, and summary exposure value (SEV) for these two risk factors. Joinpoint regression models were applied to analyze the temporal trends in associated epidemiological indicators of neonatal sepsis.
Results: From 1990 to 2019, the incidence and prevalence of neonatal sepsis in China showed a significant upwards trend compared with the largely stable trend in the USA. DALYs due to short gestation and low birthweight for neonatal sepsis in both genders showed a decreasing trend in both countries, while years lived with disability (YLDs) in China showed a fluctuating increasing trend.
Conclusions: DALYs attributed to short gestation and low birth-weight for neonatal sepsis in both countries showed a decreasing trend, while the YLDs and SEVs of these two risks are on the rise in China. Therefore, Chinese public health policy needs to be geared towards controlling these risk factors, learning from the advanced health policy planning and perinatal management experiences of developed countries, and improving neonatal follow-up and rehabilitation interventions.
... 1,[8][9][10] E. coli plays an important role in causing both early-onset sepsis (EOS) and late-onset sepsis (LOS). 3,[6][7][8][11][12][13][14] E. coli is also one of the most common pathogenic bacteria causing neonatal bacterial meningitis. [15][16][17] Neonate with E. coli meningitis can have adverse nervous system sequelae, which is an important cause of poor long-term prognosis of newborns with E. coli sepsis. ...
Background and Objective
An increasing number of cases of neonatal sepsis due to extended-spectrum beta-lactamase (ESBL)-producing multi-drug resistant (MDR) Escherichia coli (E. coli) have been reported worldwide. The aim of this study was to explore the risk factors associated with ESBL-producing MDR E. coli among neonates with culture-confirmed E. coli sepsis and thereby to help selection of appropriate empirical antibiotics.
Patients and Methods
All newborn infants with a confirmed pathogen isolated from blood or cerebrospinal fluid (CSF) from 2016 to 2021 were identified and those with E. coli infection were included in this analysis. We compared a group of neonatal patients with ESBL-producing MDR E. coli sepsis (n=69) to a group with ESBL-negative E. coli (n=70) based on antimicrobial susceptibility reports. We used multivariable regression analysis to determine the risk factors associated with ESBL-producing MDR E. coli strains among the neonates with culture-confirmed E. coli sepsis.
Results
ESBL-producing MDR E. coli sepsis was more common in premature infants and newborns with hospital-acquired late-onset sepsis (HALOS). The mortality rate of neonatal sepsis caused by ESBL-producing E. coli was about twice as that of sepsis caused by ESBL-negative E. coli. Antepartum exposure to cephalosporins (OR=25.191, 95% CI: 3.184–199.326, P<0.01) and parenteral nutrition for more than 1 week (OR=4.495, 95% CI: 2.009–10.055, P<0.01) were independent risk factors for neonatal infection with ESBL-producing stains among infants with E. coli sepsis.
Conclusion
E. coli remains the most common Gram-negative bacterial pathogen causing neonatal sepsis. A higher proportion of ESBL-producing MDR E. coli is seen in premature infants and those newborns with HALOS and is associated with higher mortality. Antepartum use of cephalosporins and prolonged use of parenteral nutrition may be important factors to consider in the selection of empirical antibiotics for use in neonatal sepsis caused by gram-negative rods prior to the availability of the results of antimicrobial susceptibility.
... Staphylococci, Klebsiella, Pseudomonas, Enterococci, and Candida species were causative agents in nosocomial sepsis. Bacteria that caused death were Gram-negative agents in early and late-onset sepsis, consistent with neonatal sepsis cases in the literature (42) . ...
... Neonatal sepsis is a worldwide burden with substantial morbidity. Late-onset sepsis (LOS), mainly occurring more than 72 h after birth, has a high mortality rate (5-15%) [1][2][3]. A meropenem dose of 10-40 mg/kg is commonly prescribed in neonates and young infants, although its use is not licensed for those under three months of age [4][5][6]. ...
... coli) and Klebsiella pneumoniae (K. pneumoniae) are the primary Gram-negative bacteria responsible for LOS, and the latter causes the most deaths [3,[9][10][11]. The data from the Chinese antimicrobial resistance surveillance network show, between 2005 and 2017, that the proportion of meropenem-resistant K. pneumoniae increases from 2.9% to 24.0% [12]. This necessitates a higher MIC cutoff, and as a consequence, the dosing regimens need to be adjusted accordingly. ...
... However, domestic reality makes this value improper. In China, the predominant Gram-negative pathogens responsible for LOS are E. coli and K. pneumoniae [3,10]. Recent efforts suggest that E. coli is susceptible to carbapenem antibiotics in China, with a resistance rate less than ...
The pharmacokinetic (PK) studies of meropenem in Chinese newborns with late-onset sepsis (LOS) are still lacking. Causative pathogens of LOS and their susceptibility patterns in China differ from the data abroad. We, therefore, conducted a developmental population pharmacokinetic–pharmacodynamic analysis in Chinese newborns with the goal to optimize meropenem dosing regimens for LOS therapy. An opportunistic sampling strategy was used to collect meropenem samples, followed by model building and validation. A Monte Carlo simulation was performed to show the probability of target attainment (PTA) for various dosages. The information from 78 newborns (postmenstrual age: 27.4–46.1 weeks) was compiled and had a good fit to a 1-compartment model that had first order elimination. The median (range) values of estimated weight–normalized volume of distribution (V)and clearance (CL) were 0.60 (0.51–0.69) L/kg and 0.16 (0.04–0.51) L/h/kg, respectively. Covariate analysis revealed that postnatal age (PNA), gestational age (GA) and current weight (CW) were the most important factors in describing meropenem PK. Simulation results showed for LOS with a minimal inhibitory concentration (MIC) of 8 mg/L, the doses of 30 mg/kg 3 times daily (TID) as a 1-h infusion for newborns with GA ≤ 37 weeks and 40 mg/kg TID as a 3-h infusion for those with GA > 37 weeks were optimal, with PTA of 71.71% and 75.08%, respectively. In conclusion, we proposed an evidence-based dosing regimen of meropenem for LOS in Chinese newborns by using the population pharmacokinetic–pharmacodynamic analysis, based on domestic common pathogens and their susceptibility patterns.
... In NICU, because of the long hospital stay, and critically ill newborns, although countries have taken a series of preventive measures. 7,8 Nosocomial infection is still a problem in NICUs all over the world. The incidence of neonatal nosocomial infection is 30% and 40% of neonatal deaths occur in developing countries, 9 Although nosocomial infection is difficult to eliminate, it can be prevented and controlled. ...
Neonatal sepsis is a serious condition in which the pathogens infiltrate the bloodstream, multiply and produce toxins causing deleterious effects to the health of neonates. It is divided into two types on the basis of the time of onset. Early onset sepsis occurs within 72 hours of birth and late onset sepsis begins after 72 hours of delivery. Neonatal sepsis continues to be a common and significant health care burden, especially in very low birth weight infants (with birthweight less than 1500 grams). Though intrapartum antibiotic prophylaxis has decreased the incidence of early-onset group B streptococcal infection dramatically, it still remains a major cause of neonatal sepsis. As the signs and symptoms of neonatal sepsis are nonspecific, early diagnosis and prompt treatment remain a challenge.
Keywords:
cytokines; immunoglobulin; neonatal sepsis; procalcitonin.
... IT ratio of more than 0.2 was considered as a case of sepsis. Procalcitonin more than 0.45 was considered as a case of sepsis [3,[17][18]. In our study, we found IT ratio mean is about 0.5 with range 0.01 -11. ...
Neonatal Late-Onset Sepsis (LOS) is a leading cause of mortality in the Neonatal Intensive Care Unit (NICU). The microbial characteristics of LOS are of primary importance in guiding clinical antisepsis practice, and strategies to prevent and treat neonatal LOS, in turn, influence the pattern of LOS pathogens. This study is a retrospective descriptive study with a cross-sectional approach conducted between 2016 until 2020 in the neonatal ward (level II-III) of the Sanglah General Hospital, Bali. Data collected consists of demography, clinical characteristics, laboratory results, and outcomes. Subjects in this study dominated by male (64%), gestational age > 37 weeks (56%), born ≥ 2.500 grams (54%), last mother education mostly in Senior High School (56%), spontaneous delivery method (54%) and 31 (62%) subjects were referral from other hospital and primary health care. Most of the subjects were lethargic (68%) and 15 (30%) subjects were died. Laboratory finding normal leukocyte, neutrophil, lymphocyte, hemoglobin, thrombocyte and IT ratio but have higher procalcitonin result. Poor outcome group were dominated by male, smaller gestational age, VLBW, and neonates who experience lethargy, temperature instability, respiratory distress and got positive blood culture.
Objective
To evaluate the regional etiology, antimicrobial resistance (AMR) pattern, and risk factors in neonates with sepsis in China.
Methods
We performed a systematic review and meta-analysis by searching Medline, Embase, Scopus, and Web of Science in December 2020. Studies of neonatal sepsis from China published between 2011 and 2020 were included. We pooled the proportion of pathogens and calculated the odds ratios of risk factors with 95% CIs using a random-effects model.
Results
We included 29 studies of 164,750 neonates with sepsis. The studies comprise data from 1990 to 2019. Coagulase-negative staphylococci (CoNS), Escherichia coli and Klebsiella spp accounted for 33% (95% CI 24–43), 17% (13–20), and 14% (11–17), respectively. Group B streptococcus (GBS) was the predominant isolate in early-onset sepsis (EOS) (21%, 95% CI 10–31), while the proportion of CoNS was the largest in late-onset sepsis (LOS) (32%, 95% CI 22–43). Resistance of CoNS to penicillin was found in 95% (95% CI 92–98) of 511 cases and Klebsiella spp to ampicillin in 95% (95% CI 90–99) of 364 cases. Maternal underlying diseases (2.61, 95% CI 1.48–4.61), mechanical ventilation (2.41, 1.37–4.23), central venous catheter placement (2.74, 1.77–4.26), peripherally inserted central catheter (PICC) placement (4.26, 2.80–6.49), multiple antibiotic uses (5.35, 1.85–15.43) and total parenteral nutrition (7.96, 2.04–31.02) were risk factors of neonatal sepsis.
Conclusion
CoNS, E. coli, and Klebsiella spp were the predominant pathogens in neonatal sepsis in China. AMR was still a significant issue in NICUs. Total parenteral nutrition, multiple antibiotic uses, and PICC placement were the most relevant risk factors.
