Antibiotics (Basel, Switzerland) · 2026
Risk Factors and Outcomes of Early-Onset Sepsis in Very Preterm Infants: Results from the Thai Neonatal Registry (ThaiNy).
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Jirapradittha Junya, Lumbiganon Dissajee, Thatrimontrichai Anucha, Swatesutipun Buranee, Jenjarat Kanmalee, Srisomsap Kullapat, Sukthong Mananya, Apiwattanaporn Manunya, Sripirom Napas, Soontaravarapas Nawamon, Sahakaro Nichanan, Preechawetchakul Ploypailin, Janyoungsak Pornpimon, Rojanakarin Pornpimon, Kosarat Shanika, Sirichaipornsak Sudarat, Kositamongkol Sudatip, Tipprasert Suparat, Pirunnet Tanin, Chitsinchayakul Thaninee, Bowornkitiwong Walaiporn, Prempunpong Chatchay, Thai Neonatal Registry (ThaiNy)
Аннотация
OBJECTIVE: To determine the incidence, causative pathogens, risk factors, and clinical outcomes of early-onset sepsis (EOS) in very preterm (gestational age < 32 weeks) and very low birth weight (birth weight < 1500 g) neonates.
METHODS: This retrospective study analyzed data from the Thai Neonatal Network registry (2019-2024; total 22 neonatal units). EOS was defined as bacteremia or bacterial meningitis within 72 h of birth.
RESULTS: Among 792 neonates (median [interquartile range] gestational age, 28 [26-29] weeks; median [interquartile range] birth weight, 960 [779-1190] g), the incidence of EOS was 4.0% (n = 32). Predominant pathogens were Escherichia coli (n = 10) and Acinetobacter baumannii (n = 9). Antibiograms showed high non-susceptibility for E. coli and A. baumannii to gentamicin (44.4% and 83.3%, respectively) and cefotaxime (37.5% and 75.0%, respectively). Although E. coli remained susceptible to amikacin and meropenem (100%), A. baumannii exhibited extensive resistance (66.7% and 83.3%, respectively). Multivariable analysis identified chorioamnionitis (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI]: 1.07-1.18) and 5 min Apgar score < 7 (aOR 1.05; 95% CI: 1.02-1.18) as significant risk factors. EOS was independently associated with increased early neonatal mortality within 7 days of life (aOR, 1.26; 95% CI: 1.16-1.36).
CONCLUSIONS: The incidence of EOS is high among very preterm infants in Thailand and significantly increases mortality rates. The prevalence of multidrug-resistant A. baumannii in neonatal EOS is a critical concern that limits the efficacy of empirical treatments. These findings highlight the urgent need for targeted interventions and enhanced antimicrobial stewardship to improve neonatal survival rates.
METHODS: This retrospective study analyzed data from the Thai Neonatal Network registry (2019-2024; total 22 neonatal units). EOS was defined as bacteremia or bacterial meningitis within 72 h of birth.
RESULTS: Among 792 neonates (median [interquartile range] gestational age, 28 [26-29] weeks; median [interquartile range] birth weight, 960 [779-1190] g), the incidence of EOS was 4.0% (n = 32). Predominant pathogens were Escherichia coli (n = 10) and Acinetobacter baumannii (n = 9). Antibiograms showed high non-susceptibility for E. coli and A. baumannii to gentamicin (44.4% and 83.3%, respectively) and cefotaxime (37.5% and 75.0%, respectively). Although E. coli remained susceptible to amikacin and meropenem (100%), A. baumannii exhibited extensive resistance (66.7% and 83.3%, respectively). Multivariable analysis identified chorioamnionitis (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI]: 1.07-1.18) and 5 min Apgar score < 7 (aOR 1.05; 95% CI: 1.02-1.18) as significant risk factors. EOS was independently associated with increased early neonatal mortality within 7 days of life (aOR, 1.26; 95% CI: 1.16-1.36).
CONCLUSIONS: The incidence of EOS is high among very preterm infants in Thailand and significantly increases mortality rates. The prevalence of multidrug-resistant A. baumannii in neonatal EOS is a critical concern that limits the efficacy of empirical treatments. These findings highlight the urgent need for targeted interventions and enhanced antimicrobial stewardship to improve neonatal survival rates.