Distribution of Pathogenic Bacteria in Health Care Associated Sepsis in Preterm Infants and Ten Years Variation in Their Drug Resistance.

AIM: To identify the causative bacteria of healthcare-associated sepsis in preterm infants and analyze their antibiotic resistance trends over ten years, providing evidence for infection prevention strategies.

MATERIALS AND

METHODS

We retrospectively analyzed blood culture data from preterm infants (<37 weeks) with healthcare-associated sepsis (onset >72 hours after birth) admitted between January 2014 and December 2023. Pathogen distribution and antibiotic resistance patterns were compared between two periods (2014-2018 vs 2019-2023).

RESULTS

Among 9928 preterm infants, 3.3% (332 cases) had positive blood cultures, with incidence increasing from 1.4% (2014-2018) to 2.7% (2019-2023). Gram-negative bacteria remained predominant (48.00% to 61.07%), led by Klebsiella pneumoniae. Gram-positive bacteria increased significantly (5.33% to 31.30%), primarily coagulase-negative staphylococci, while fungal infections decreased (46.67% to 7.63%). Resistance to third-generation cephalosporins persisted in K. pneumoniae (~80%) and increased in Enterobacter cloacae (60% to 90%). Emerging carbapenem resistance was observed in E. coli (0% to 33.33%) and K. pneumoniae (5.25% to 4.08%), with Enterobacter cloacae showing a significant rise (0% to 60%). ESBL-producing strains rose from 13.33% to 30.53%. All Gram-positive isolates remained susceptible to linezolid, except one vancomycin-resistant Staphylococcus capsulatus.

CONCLUSION

The incidence of healthcare-associated sepsis in preterm infants increased significantly, with rising carbapenem resistance in Gram-negative bacteria and a marked increase in coagulase-negative staphylococci. These trends underscore the need for enhanced infection control and judicious antibiotic use guided by blood culture results.