Clinical manifestations and treatment of early-onset neonatal sepsis: a Chinese-French comparison

Abstract

To realize the difference between China and France in the clinical manifestations, diagnosis and treatment of early-onset neonatal sepsis (EONS) and to provide basis to improve the level of our hospital in diagnosing and treating this disease. Data of 146 cases of EONS were retrospectively analyzed. All data were collected from our hospital and a French hospital. Bacterial spectrum, clinical manifestations, use of antibacterial drugs, occurrence of recording and screening of perinatal risk factors were compared between the two hospitals. The most common pathogenic bacteria in our hospital were coagulase-negative staphylococcus (69.2%) and Escherichia coli (15.4%) while in the French Hospital, group B streptococcus (33.3%) and Escherichia coli (33.3%). The most common pathogenic bacteria in gastric liquid and peripheral swabs of the French hospital were Escherichia coli (33.3%) and group B streptococcus (21.2%). Total days of antibacterial use 11.4 ± 7.2 (d), mean sorts of antibacterial drugs for single patient (3.1 ± 0.9) and proportion of patients who had antibacterial drug changes (70.2%) were greater than the French hospital 6.2 ± 2.5 (d), 2.2 ± 0.8(d), (9.9%). Both hospitals were inclined to combine 2 antibacterial drugs for the first dose (second-generation cephalosporins + semi-synthetic penicillin in our hospital vs. amoxicillin + amikacin in the French hospital). The common second and third line antibacterial drugs in our hospital are carbapenems and vancomycin vs. third-generation cephalosporins and vancomycin in the French hospital. The rates of occurrence of recording and screening perinatal risk factors (chorioamnionitis, maternal fever, prolonged rupture of membranes, screening results of vaginal swabs or urinary infection, amniotic fluid contamination, prenatal antibacterial prophylaxis, anamnesis of EONS) in our hospital was all lower than those of the French hospital. There was no significant difference in positive rate of perinatal risk factors between the two hospitals. For newborns hospitalized for immediate abnormalities after birth, the most common symptom was respiratory distress (96.5% vs. 88.2%). For those admitted after a period of time after birth, the proportion of abnormalities was different: in our hospital, the most common reasons were respiratory distress (44.4%) and lethargy (22.2%) while in the French hospital there were rise of C reactive proteins (78.2%) and fever (5.5%). The false negative rate of C reactive proteins in diagnosing EONS was not significantly different between the two hospitals. There was significant difference in diagnosing and treating EONS in the two hospitals. Emphasis on screening and recording perinatal risk factors, as well as strengthened surveillance on neonates in obstetric department could improve the accuracy of early diagnosis of EONS of our hospital. Positive attitude to gastric liquid and peripheral swabs culture, with drug susceptibility test may help pediatricians better select antibacterial drugs and reduce unnecessary changes and the total time of antibiotic use.