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Lee CC, Chen PL, Ho CY, Hong MY, Hung YP, Ko WC. Prompt antimicrobial therapy and source control on survival and defervescence of adults with bacteraemia in the emergency department: the faster, the better. Crit Care 2024; 28:176. [PMID: 38790061 PMCID: PMC11127347 DOI: 10.1186/s13054-024-04963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Bacteraemia is a critical condition that generally leads to substantial morbidity and mortality. It is unclear whether delayed antimicrobial therapy (and/or source control) has a prognostic or defervescence effect on patients with source-control-required (ScR) or unrequired (ScU) bacteraemia. METHODS The multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model. RESULTS Of the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness. CONCLUSIONS Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.
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Affiliation(s)
- Ching-Chi Lee
- Clinical Medical Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
| | - Po-Lin Chen
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
| | - Ching-Yu Ho
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, No.57, Sec. 1, Dongmen Road, East Dist., Tainan, 70142, Taiwan
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Ming-Yuan Hong
- Departments of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
| | - Yuan-Pin Hung
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
- Department of Medicine, Medical College, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, No. 125, Jhongshan Rd., West Central Dist., Tainan City, Taiwan
| | - Wen-Chien Ko
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
- Department of Medicine, Medical College, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
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Shao H, Zhang X, Li Y, Gao Y, Wang Y, Shao X, Dai L. Epidemiology and drug resistance analysis of bloodstream infections in an intensive care unit from a children's medical center in Eastern China for six consecutive years. Int Microbiol 2024:10.1007/s10123-024-00481-2. [PMID: 38233723 DOI: 10.1007/s10123-024-00481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Children in the intensive care unit (ICU) who suffer from severe basic diseases and low immunity are usually in critical condition. It is crucial to assist clinicians in selecting the appropriate empirical antibiotic therapies for clinical infection control. METHODS We retrospectively analyzed data from 281 children with bloodstream infection (BSI). Comparisons of basic data, pathogenic information, and drug resistance of the main bacteria were conducted. RESULTS We detected 328 strains, including Gram-positive bacteria (223, 68%), mainly coagulase-negative Staphylococci (CoNS); Gram-negative bacteria (91, 27.7%); and fungi (14, 4.3%). The results of the binary logistic regression analysis showed that the main basic disease was an independent risk factor for death. Compared with Escherichia coli, Klebsiella pneumoniae exhibited a higher proportion of extended-spectrum β-lactamases (ESBLs), and its resistance to some β-lactamides and quinolones antibiotics were lower. Twenty-seven isolates of multidrug-resistant (MDR) bacteria were detected, of which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for the highest proportion (13, 48.2%). CONCLUSIONS CoNS was the principal pathogen causing BSI in children in the ICU of children, and Escherichia coli was the most common Gram-negative pathogen. The main basic disease was an independent risk factor for death. It is necessary to continuously monitor patients with positive blood cultures, pay special attention to detected MDR bacteria, and strengthen the management of antibiotics and prevention and control of nosocomial infections.
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Affiliation(s)
- Huijiang Shao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China
| | - Xin Zhang
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Yang Li
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Yuanyuan Gao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China
| | - Yunzhong Wang
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China
| | - Xuejun Shao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China.
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215025, China.
| | - Ling Dai
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215025, China.
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215025, China.
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Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-Resistant Sepsis: A Critical Healthcare Challenge. Antibiotics (Basel) 2024; 13:46. [PMID: 38247605 PMCID: PMC10812490 DOI: 10.3390/antibiotics13010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects.
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Affiliation(s)
- Nishitha R. Kumar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Tejashree A. Balraj
- Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India;
| | - Swetha N. Kempegowda
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
- Department of Medical Genetics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India
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Liu Y, Sun T, Cai Y, Zhai T, Huang L, Zhang Q, Wang C, Chen H, Huang X, Li M, Xia J, Gu S, Guo L, Yang B, Wu X, Lu B, Zhan Q. Clinical characteristics and prognosis of pneumonia-related bloodstream infections in the intensive care unit: a single-center retrospective study. Front Public Health 2023; 11:1249695. [PMID: 37744495 PMCID: PMC10516289 DOI: 10.3389/fpubh.2023.1249695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Bloodstream infections (BSI) are one of the most severe healthcare-associated infections in intensive care units (ICU). However, there are few studies on pneumonia-related BSI (PRBSI) in the ICU. This study aimed to investigate the clinical and prognostic characteristics of patients with PRBSI in the ICU and to provide a clinical basis for early clinical identification. Methods We retrospectively collected data from patients with bacterial BSI in a single-center ICU between January 1, 2017, and August 31, 2020. Clinical diagnosis combined with whole-genome sequencing (WGS) was used to clarify the diagnosis of PRBSI, and patients with PRBSI and non-PRBSI were analyzed for clinical features, prognosis, imaging presentation, and distribution of pathogenic microorganisms. Results Of the 2,240 patients admitted to the MICU, 120 with bacterial BSI were included in this study. Thirty-two (26.7%) patients were identified as having PRBSI based on the clinical diagnosis combined with WGS. Compared to patients without PRBSI, those with PRBSI had higher 28-day mortality (81.3 vs.51.1%, p = 0.003), a higher total mortality rate (93.8 vs. 64.8%, p = 0.002), longer duration of invasive mechanical ventilation (median 16 vs. 6 days, p = 0.037), and prolonged duration of ICU stay (median 21 vs. 10 days, p = 0.004). There were no differences in other baseline data between the two groups, but patients with PRBSI had extensive consolidation on chest radiographs and significantly higher Radiographic Assessment of Lung Edema scores (mean 35 vs. 24, p < 0.001). The most common causative organisms isolated in the PRBSI group were gram-negative bacteria (n = 31, 96.9%), with carbapenem-resistant gram-negative bacteria accounting for 68.8% (n = 22) and multidrug-resistant bacteria accounting for 81.3% (n = 26). Conclusion Pneumonia-related BSI is an important component of ICU-BSI and has a poor prognosis. Compared to non-PRBSI, patients with PRBSI do not have typical clinical features but have more severe lung consolidation lesions, and should be alerted to the possibility of their occurrence when combined with pulmonary gram-negative bacterial infections, especially carbapenem-resistant bacteria. Further multicenter, large-sample studies are needed to identify the risk factors for the development of PRBSI and prevention and treatment strategies.
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Affiliation(s)
- Yijie Liu
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ting Sun
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Cai
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Tianshu Zhai
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Linna Huang
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qi Zhang
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chunlei Wang
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - He Chen
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xu Huang
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Min Li
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jingen Xia
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Sichao Gu
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Lingxi Guo
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Bin Yang
- Vision Medicals Center for Infection Diseases, Guangzhou, China
| | - Xiaojing Wu
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang University, Jiangxi, China
| | - Binghuai Lu
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qingyuan Zhan
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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Zou H, Jia X, He X, Su Y, Zhou L, Shen Y, Sheng C, Liao A, Li C, Li Q. Emerging Threat of Multidrug Resistant Pathogens From Neonatal Sepsis. Front Cell Infect Microbiol 2021; 11:694093. [PMID: 34322398 PMCID: PMC8312093 DOI: 10.3389/fcimb.2021.694093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Multidrug-resistant (MDR) pathogens are responsible for a substantial burden of morbidity and mortality from neonatal sepsis; however, data on these sepsis-related pathogens among hospitalized neonates in China are not well characterized. In this study, a total of 240 strains were isolated from four Women and Children's hospitals in Southwest China between 2014 and 2019. Of these included pathogens, 104 (43.33%) were gram-positive bacteria, 129 (53.75%) were gram-negative bacteria, and 7 (2.92%) were fungi. Escherichia coli (E. coli, 34.01%) and Klebsiella pneumoniae (K. pneumoniae, 15.35%) were the main pathogen of neonate bacteremia. ST167 were the most prevalent STs in E. coli and ST11 in K. pneumoniae. Our study found that E. coli (62.71%) was the predominate pathogen of early-onset sepsis, among which 64.86% were MDR. Late-onset sepsis was mainly caused by K. pneumoniae (28.31%) and E. coli (24.78%), with showing that 78.33% of these pathogens were MDR. Notably, the prevalence of EO/LO pathogens were quite different from Indian and south of China. Moreover, we found that bla CTX-M (42.06%) was most dominant resistant genes with about a third isolates (31.09%) were positive for bla CTX-M-15. All the carbapenem-resistant K. pneumoniae were positive for NDM-1. Moreover, late-onset sepsis and antibiotic exposure were significantly associated with MDR infection. Emerging multi-resistant pathogens of sepsis posts a serious threat to neonatal outcomes and emphasizes an urgent need to control their further spread.
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Affiliation(s)
- Hua Zou
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaojiong Jia
- Department of Laboratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao He
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Su
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ligang Zhou
- Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Shen
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Chenglin Sheng
- Department of Laboratory Medicine, Wan Zhou Health Center for Women and Children, Chongqing, China
| | - Ang Liao
- Department of Laboratory Medicine, Yong Chuan Health Center for Women and Children, Chongqing, China
| | - Chunli Li
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Qiuhong Li
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
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