Early-onset Sepsis Among Preterm Neonates in China, 2015 to 2018

Abstract

Background: The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China. Methods: All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth. Results: Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks’ gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity. Conclusions: There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.

Epidemiology and antimicrobial susceptibility of invasive Escherichia coli infection in neonates from 2012 to 2019 in Xiamen, China

“…In a study conducted at a tertiary hospital in India, the rate of neonatal sepsis with blood culture positivity was 6.2%, of which E. coli accounted for 14% [15]. In a study conducted across 25 tertiary hospitals in China from 2015 to 2018, the incidence of neonatal early-onset sepsis caused by E. coli in preterm infants younger than 34 weeks of gestation was 2.36/1000 LBs [6]. In recent years, E. coli has replaced group B streptococcus as the most common causative pathogen of neonatal purulent meningitis in Taiwan [16].…”

“…In an Italian study, the incidence of neonatal late-onset E. coli sepsis was found to be 0.35/1000 LBs [5]. In China, E. coli is the main causative pathogen of neonatal invasive infection, especially neonatal sepsis [6].…”

Neonatal sepsis: within and beyond China

“…Based on a recent multicenter study including preterm infants <34 weeks’ gestation admitted to 25 tertiary neonatal units in China (2015–2018), the incidence of EOS was 11.7 cases per 1000 admissions (321/27,532) or 9.7 cases per 1000 LBs if only inborn infants in 18 perinatal centers were considered (186/19,084). [ 17 ] The leading pathogen was Gram-negative bacteria (GNB) like E. coli (20.3%), followed by coagulase-negative staphylococci (CoNS) (16.5%), whereas EOS caused by GBS was relatively rare (2.5%). [ 17 ] The case fatality rate of EOS in China was 19% (61/321).…”

“…[ 17 ] The leading pathogen was Gram-negative bacteria (GNB) like E. coli (20.3%), followed by coagulase-negative staphylococci (CoNS) (16.5%), whereas EOS caused by GBS was relatively rare (2.5%). [ 17 ] The case fatality rate of EOS in China was 19% (61/321). [ 17 ]…”

“…[ 25 ] Notably, the predominance of nosocomial and opportunistic pathogens (eg, GNB and CoNS) among neonatal EOS cases in China raised the concern of possible unhygienic practices or inappropriate perinatal exposure to antibiotics favoring intestinal translocation of GNB. [ 17 ]…”