Abstract
IntroductionTo analyze the pathogen distribution and drug resistance of newborns with bloodstream infection (BSI) to help clinicians choose the appropriate empirical antibiotic therapy for clinical infection control.MethodsA total of 707 neonatal BSI cases were retrospectively analyzed. The bacteria in blood culture-positive samples were cultured, identified, and analyzed for drug sensitivity by routine methods. Statistical software was used to compare and analyze the basic data, pathogenic information, and drug resistance of the main bacteria.ResultsThe 5-year average positive rate of neonatal blood culture was 2.50%. The number of specimens submitted for inspection in 2020 significantly decreased. The top five infectious pathogens with the highest proportion were coagulase-negative Staphylococcus (67.35%), of which Staphylococcus epidermidis had the highest proportion (31.26%), followed by Escherichia coli (12.87%), Klebsiella pneumoniae (9.05%), Streptococcus agalactiae (8.63%), and Staphylococcus aureus (3.25%). Gram-positive (G+) bacteria were dominant, accounting for 69.45%. The main G+ bacteria had a higher rate of resistance to erythromycin and penicillin G. The main Gram-negative (G–) bacteria had a high resistance rate to a variety of antibacterial drugs, especially cephalosporin antibiotics. The overall resistance of K. pneumoniae was higher than that of E. coli. The top two fungi detected were Candida parapsilosis and Candida albicans. C. parapsilosis did not appear to be resistant to antibiotics, while C. albicans was resistant to multiple antibiotics. The type of microbial infection had a statistically significant difference in the positive rate among the age at delivery and wards (p < 0.05). There were significant differences in the detection of fungi among these groups (p < 0.05). The positive rate of G+ bacteria in the term newborns was significantly higher than that in the preterm newborns (p < 0.05). Preterm newborns are more susceptible to pneumonia.ConclusionG+ bacteria are the main pathogens of neonatal BSI. Preterm newborns are more likely to be infected with G– bacteria. E. coli and K. pneumoniae are the most common G– bacteria, and both have a high resistance rate to a variety of antibacterial drugs. According to the distribution characteristics and drug resistance, it is very important to select antibiotics reasonably.
Highlights
To analyze the pathogen distribution and drug resistance of newborns with bloodstream infection (BSI) to help clinicians choose the appropriate empirical antibiotic therapy for clinical infection control
According to the different admission wards, newborns who have been assessed by the doctor in serious condition will be admitted to the neonatal intensive care unit (NICU) (6,628 cases), and other newborns will be admitted to the general neonatology unit (21,659 cases)
Staphylococcus has over 80% resistance to penicillin G, and S. agalactiae is 100% sensitive to penicillin G
Summary
To analyze the pathogen distribution and drug resistance of newborns with bloodstream infection (BSI) to help clinicians choose the appropriate empirical antibiotic therapy for clinical infection control. In 2017, the National Bacterial Drug Resistance Monitoring Network reported that 15.2% of bacterial infections in China came from blood samples (Hu et al, 2018). The treatment and survival of newborns, especially premature babies, often rely on effective antibiotics, but due to the delay in laboratory tests, empirical medication is often given before the results are available (Puopolo et al, 2018). Grasping the distribution characteristics of BSI pathogens in a certain area and performing empirical treatment for the first time are of great significance to saving the lives of newborns. A retrospective study of 707 clinical cases of neonatal BSI in East China was performed to understand the composition of pathogenic bacteria and bacterial resistance.
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