Etiology, antimicrobial resistance, and risk factors of neonatal sepsis in China: a systematic review and meta-analysis from data of 30 years

Abstract

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.