Clinical characteristics, bacterial profiles and antimicrobial resistance of neonates with bloodstream infection caused by ESKAPEEc pathogens in Southwest China.

BACKGROUND

Data focusing on neonatal bloodstream infections (BSIs) caused by ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli ) was scarce. This study was conducted to explore the clinical and microbiological aspects of ESKAPEEc BSI in neonates.

METHODS

A retrospective study was performed in neonates with culture-confirmed BSI at the Children’s Hospital of Chongqing Medical University, between January 2015 and December 2020. Clinical data, causative organisms, and antimicrobial susceptibility profiles were comprehensively collected and analyzed.

RESULTS

In total, 625 patients were enrolled; 346 had infections caused by ESKAPEEc pathogens (prevalence, 55.4%; 95% confidence interval, 51.5–59.3%). Klebsiella pneumoniae (144/625; 23.0%) was the predominant ESKAPEEc pathogen causing neonatal BSI, followed by Escherichia coli (104/625; 16.6%), and Enterococcus faecium (55/625; 8.8%). Klebsiella pneumoniae (138/556; 24.8%) was the dominant ESKAPEEc in neonates presenting with late-onset sepsis (LOS), while Escherichia coli (14/69; 20.3%) was the most frequent ESKAPEEc isolated among patients with early-onset sepsis (EOS). Moreover, the resistance rates of Gram-negative ESKAPEEc to third-generation cephalosporins, piperacillin/tazobactam, aminoglycosides, and fluoroquinolones were statistically higher than the values of the Gram-negative non-ESKAPEEc (all p < 0.05). Notably, 9.0%–31.8% of Gram-negative ESKAPEEc and 0%–25.9% of Gram-negative non-ESKAPEEc species were resistant to carbapenem, whereas the carbapenem resistance rates were not statistically different between the 2 groups (all p > 0.05). Gram-positive ESKAPEEc and Gram-positive non-ESKAPEEc isolates showed relatively high resistance levels to multiple antibiotics. 1(1/331; 0.3%) vancomycin-resistant coagulase-negative Staphylococcus (CoNS) was observed. In addition, low birthweight and preterm birth were significantly associated with both ESKAPEEc infection and ESKAPEEc-related mortality (all P < 0.05). Neonates with ESKAPEEc BSI had higher rates of concurrent meningitis (17.9% vs. 9.3%, p = 0.002) and mortality (6.4% vs. 2.5%, p = 0.023).

CONCLUSIONS

Over half of neonates presenting with BSI were ascribed to ESKAPEEc pathogens. Klebsiella pneumoniae and Escherichia coli were the dominant ESKAPEEc pathogens. The distribution of ESKAPEEc organisms in neonatal BSI differed by timing of infection onset. ESKAPEEc infections and ESKAPEEc-related mortality occurred more frequently among preterm neonates or those with lower birthweight. The high resistance rates of Gram-negative ESKAPEEc were of serious concern.