591 - Culture-proven sepsis among very preterm infants in neonatal intensive care units in China

Publication Number: 591.4233

Weiyin Yu, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Shujuan Li, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jinglin Chen, Children‘s hospital of fudan university, 上海市 / 市辖区 / 杨浦区, Shanghai, China (People's Republic); Jie Yang, Fudan Children's Hospital, Shanghai, Shanghai, China (People's Republic); Shoo K Lee, Mount Sinai Hospital, Toronto, ON, Canada; Yun Cao, Children's Hospital, Fudan University, Shanghai, PRC, Shanghai, Shanghai, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic)

Background: Culture-proven sepsis remains a significant cause of mortality and morbidity among neonates, especially in very preterm infants (VPIs). Ongoing cross-national surveillance is essential but scarce in China.

Objective: We aimed to describe the epidemiology, resistance pattern and antibiotic therapy for culture-proven sepsis among VPIs across China.

Design/Methods: This was a cross-sectional study of infants born at < 32 weeks’ gestation admitted to the neonatal intensive care units (NICUs) in the Chinese Neonatal Network between 2019-2022. Culture-proven sepsis was defined by a positive blood or CSF culture. Early-onset sepsis (EOS) was defined as sepsis occurring within 72h after birth. Late-onset sepsis (LOS) was defined as sepsis occurring after 72h of birth. Multidrug resistance (MDR) bacteria included methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, gram-negative bacteria producing extended spectrum β-lactamases, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa. Sepsis-related death was defined as death occurred within 7 days of the positive culture.

Results: Of infants admitted within 3 days after birth, 366 had EOS with an incidence of 1.1% (366/33669). Of infants survived more than 3 days, 2139 had LOS with an incidence of 5.8% (2139/36704). Overall, 24.0% (88/366) of EOS infants and 12.2% (262/2139) of LOS infants died. Sepsis related death rate of EOS and LOS was 17.8% (65/366) and 7.9% (170/2139). Escherichia coli (38.3%) was the most common EOS pathogen, while coagulase negative staphylococci (23.5%) were most isolated among LOS episodes (Table 1). 59.5% of S. aureus strains were MRSA (Table 2). E. coli (70.8%) and K. pneumoniae (71.8%) had high percentage of resistant to third-generation cephalosporin (Table3). In terms of empirical therapy, penicillins (58.1%, 173/298) and carbapenem (54.8%, 837/1553) was most frequently used for EOS and LOS. 31.1% (91/298) of EOS infants received empirically carbapenem treatment. For definitive therapy, vancomycin/linezolid (76.2%, 793/1040) and carbapenem (67.6%, 779/1152) were most prescribed for Gram-positive and Gram-negative bacteria. The major antifungal agent was fluconazole.

Conclusion(s): Culture-proven sepsis associated mortality for VPIs was notable in Chinese NICUs, with a high burden of multidrug resistance. VPIs experienced inappropriate antibiotic therapy for sepsis. Preventive and treatment strategies of sepsis should be developed and focused on these characteristics in China.

Table 1 Pathogens causing sepsis among infants born at <32 weeks’ gestational age in Chinese NICUs


Table 2 Resistance of common Gram-positive pathogens causing sepsis among infants born at <32 weeks’ gestational age in Chinese NICUs in 2022
IR, intrinsic resistance; NA, not applicable
*except for high-level resistance testing

Table 3 Resistance of common Gram-negative pathogens causing sepsis among infants born at <32 weeks’ gestational age in Chinese NICUs in 2022
IR, intrinsic resistance; NA, not applicable