Etiology, antimicrobial resistance, and risk factors of neonatal sepsis in China: a systematic review and meta-analysis from data of 30 years

Abstract

Objective

To evaluate the regional etiology, antimicrobial resistance (AMR) pattern, and risk factors in neonates with sepsis in China.

Methods

We performed a systematic review and meta-analysis by searching Medline, Embase, Scopus, and Web of Science in December 2020. Studies of neonatal sepsis from China published between 2011 and 2020 were included. We pooled the proportion of pathogens and calculated the odds ratios of risk factors with 95% CIs using a random-effects model.

Results

We included 29 studies of 164,750 neonates with sepsis. The studies comprise data from 1990 to 2019. Coagulase-negative staphylococci (CoNS), Escherichia coli and Klebsiella spp accounted for 33% (95% CI 24–43), 17% (13–20), and 14% (11–17), respectively. Group B streptococcus (GBS) was the predominant isolate in early-onset sepsis (EOS) (21%, 95% CI 10–31), while the proportion of CoNS was the largest in late-onset sepsis (LOS) (32%, 95% CI 22–43). Resistance of CoNS to penicillin was found in 95% (95% CI 92–98) of 511 cases and Klebsiella spp to ampicillin in 95% (95% CI 90–99) of 364 cases. Maternal underlying diseases (2.61, 95% CI 1.48–4.61), mechanical ventilation (2.41, 1.37–4.23), central venous catheter placement (2.74, 1.77–4.26), peripherally inserted central catheter (PICC) placement (4.26, 2.80–6.49), multiple antibiotic uses (5.35, 1.85–15.43) and total parenteral nutrition (7.96, 2.04–31.02) were risk factors of neonatal sepsis.

Conclusion

CoNS, E. coli, and Klebsiella spp were the predominant pathogens in neonatal sepsis in China. AMR was still a significant issue in NICUs. Total parenteral nutrition, multiple antibiotic uses, and PICC placement were the most relevant risk factors.

Keywords:

• Sepsis
• neonates
• etiology
• antimicrobial resistance
• China

Disclosure statement

The authors report no conflict of interest.

Author contributions

YQY designed the study and drafted the initial manuscript. YQY, XRH, and LJW collected the data. YQY, XRH, and YHY analyzed the data. All authors reviewed and revised the manuscript. PYC contributed to the concept, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data are available from the corresponding author.

Additional information

Funding

This study was funded by The Clinical Big Data System of Central South University: The Clinical Big Data System for Premature Infants [056].