Clinical Characteristics and Antimicrobial Resistance of Escherichia coli Bloodstream Infections in Neonates: A Retrospective Study.

BACKGROUND

Escherichia coli (E. coli) bloodstream infections (BSIs) are a significant public health concern. This study aimed to examine the clinical characteristics, laboratory indicators, outcomes, and antimicrobial resistance patterns of E. coli BSIs in neonatal populations.

MATERIALS AND

METHODS

A retrospective analysis was conducted from January 2017 to December 2023 at Guangxi Children's Hospital in China. We compared neonatal and non-neonatal patient groups, analyzing clinical parameters, lab results, and antimicrobial susceptibility patterns. Using multivariable regression analysis, we identified specific laboratory markers as prognostic indicators for ICU admission in newborns with E. coli BSIs. Diagnostic efficacy was assessed using ROC curves, sensitivity, and specificity.

RESULTS

The study analyzed 179 hospitalized patients with E. coli BSIs, including 91 neonates (0-28 days) and 88 older pediatric cases. Among the neonates, 52 (57%) required ICU admission, while the remaining 39 (43%) were managed in general pediatric wards. In neonates, the highest resistance rate was observed for ampicillin (83.52%), followed by sulfamethoxazole (51.65%) and cefazolin (46.15%). Non-neonates exhibited higher resistance to ceftazidime (P=0.022), imipenem (P=0.021), meropenem (P=0.023), and other antibiotics. Multivariate analysis showed that decreased albumin (ALB) and total bile acid (TBA) levels, along with increased direct bilirubin (DBIL), were independent risk factors for ICU admission. Findings indicated that when ALB <33.06 g/L, TBA <8.2 μmol/L, and DBIL >14.64 μmol/L, the risk of ICU admission for neonates increased.

CONCLUSION

E. coli BSIs in neonates and non-neonates exhibit distinct clinical features and resistance profiles. Low ALB and TBA, and high DBIL were found to be important predictors of ICU admission in neonates. Close monitoring of these markers can improve outcomes for high-risk neonates with E. coli BSIs.