| ObjectiveNeonatal sepsis (NS) is a serious infection disease in neonates, with high morbidity and mortality. Analysis of regional changing trends of the pathogens of sepsis and their antibiotic susceptibility pattern might assist in the formulation of strategies to treat and prevent neonatal sepsis. Timely and rational antimicrobial therapy might reduce the mortality of NS. But, the pathogens and their antibiotics susceptibility pattern varied from place to place and from time to time. This study was designed to analyze the changes tendency of the pathogens and their antibiotics susceptibility of NS in the Southwest of China.MethodsMedical charts were reviewed for all neonates with sepsis admitted in the Department of Neonatology, Children’s Hospital of Chongqing Medical University in Chongqing between January 1993 and September 2014. A retrospective study was designed to analyze the demographic information of the neonates, the constituent ratio and the changes tendency of the pathogens and their antibiotics susceptibility. SPSS version 13.0 (SPSS, Chicago, IL, USA) was employed for date handling and analysis.Result1245 neonates were included in our study. For early-onset sepsis (EOS) (n=596), Staphylococcus (53.6%, n=339) was the major pathogen, followed by Enterobacter (12.7%, n=80) and Klebsiella (7.1%, n=45). For late-onset sepsis (LOS)(n=649), the most common pathogens were Staphylococcus(50.8%, n=356), Enterobacter (9.8%, n=69), Klebsiella (9.7%, n=68) and Fungi(7.4%, n=52).During the study period, the constituent ratio of the gram-positive cocci decreased from 71% to 43%, and the proportion of the gram-negative bacillus increased from 14% to 55% in EOS. Meanwhile, as the major part of the gram-positive cocci, Staphylococcus fell from 65% to 37%, and as the most common pathogens of the gram-negative bacillus, Enterobacter and Klebsiella increased from 4% to 36% and 2% to 15%, respectively. And an increased trend from 10% to 38% was observed in the gram-negative bacillus, while as the major pathogens of LOS, the gram-positive cocci had decline from 80% to 47% during the study period. As the major part of gram-positive cocci, the constituent ratio of Staphylococcus decreased from 68% to 35%. As the most common pathogens of gram-negative bacillus, the constituent ratio of Enterobacter and Klebsiella had overall increased from 5% to 17% and 2% to 18%,respectively.At the same time, we found the constituent ratio of Fungi in EOS was only 0.5%(n=3), but in it was one of the most common parts of LOS, whose constituent ratio was 7.4%(n=52) in LOS. And the Fungi increased from 3% to 20% during 2005-2014.For the gram-positive cocci, the susceptibility of Teicoplanin and Vancomycin were more than 90%, followed by Linezolid, Synercid and Rifampicin(between 80% and 90%). And the susceptibility of Erythromycin and some Cephalosporins(Cefotaxime, Cefoxitin and Cefazolin), even to some widely-used antibiotics in developed countries, such as Penicillins (Penicillin, Ampicillin, Oxacillin and Amoxicillin/clavulanic acid) only between 20% to 40%. Similar with the gram-positive cocci, for the gram-negative bacillus, more than 70% susceptibility to Impipenem, Sparfloxacin, Ciprofloxacin and Gentamicin were found, while some Penicilins and Cephalosporins (Ampicillin and Cefazolin) were only between 20% to 40% in the present study.Furthermore, in the antibiotics susceptibility of the bacterial, we found no matter EOS and LOS, the susceptibility of Vancomycin to Staphylococcus and Enterococcus were more than 80%. And more than 80% susceptibility of Carbapenems and Aminoglycosides to Klebsiella pneumoniae(K.pneumoniae) and Escherichia coli(E.coli) were also found. Meanwhile, for most pathogens in our study, the sensitivity of most Penicillins (such as Penicillin, Ampicillin, Oxacillin) and Cephalosporins (such as Cefotaxime, Cephalothin and Cefazolin) are all lower than 30%. In addition, the susceptibility of common used antifungals in clinical such as Amphotericin B, Itraconazole, and 5-fluorocytosine to Fungi were more than 70%.An important finding in our study is the susceptibility of most common used antibiotics against gram-positive cocci decreased year by year. The susceptibility of Vancomycin to the gram-positive cocci in EOS declined from approximately 95% to 65% during 1993-2014, and Gentamicin and Ciprofloxacin were also decreased from about 70% to 40% and from 80% to 50%, respectively. For the gram-negative bacillus in EOS, the susceptibility of Impipenem and Ciprofloxacin remained stably more than 80% during the study period. And the susceptibility of Ampicillin to both the gram-positive cocci and gram-negative bacillus stayed less than 40% during the study period. The change tendency of antibiotics susceptibility in LOS was also found, the susceptibility of Vancomycin and Ciprofloxacin to the gram-positive cocci in LOS decreased from 100% to 60% and to 56% respectively. For the gram-negative bacillus in LOS, stability above 70% susceptibility of Impipenem, Ciprofloxacin and Gentamicin were observed in our study. And the susceptibility of some Penicillins (such as Ampicillin, Oxacillin) were stayed less than 30% during the study period.Conclusion1. In both EOS and LOS, the gram-positive cocci was the most common pathogen, which was mainly composed of Staphylococcus and Enterococcus. The gram-negative bacillus was the secondly common pathogen of NS and mainly composed of Enterobacter, Klebsiella and Fungi.2. Additionally, the constituent ratio of both the gram-positive and Staphylococcus decreased overall during the study period, while the gram-negative bacillus increased. In the upward trend of the gram-negative bacillus, Enterobacter had a striking increase trend in EOS, while a slight increase tendency in several gram-negative bacterial including Enterobacter and Klebsiella were found in LOS.3. In EOS, the constituent ratio of Fungi was small, but much larger in LOS, and it increased year by year since 2005.4. During the study of the antibiotics susceptibility of the pathogens, the gram-positive cocci was sensitive to Vancomycin, Teicoplanin and Rifampicin in both EOS and LOS, and Imipenem, Sparfloxacin, Ciprofloxacin and Gentamicin showed high sensitive to the gram-negative bacillus.5. Similar susceptibility pattern was also found in the analysis of the antibiotics susceptibility of some common bacterial. Vancomycin was the best sensitive antibiotics for Staphylococcus and Enterococcus in our study, and Carbapenems(such as Imipenem, Meropenem) and Fluoroquinolones(Ciprofloxacin, Sparfloxacin and Moxifloxacin) were highly susceptible to E.coli and K.pneumoniae. Most Penicillins(such as Penicillin and Ampicillin) and Cephalosporins(such as Cefazolin, Cefotaxime and Cefoxitin) showed obviously resistant to both the gram-positive cocci and gram-negative bacillus. Additionally, the common used antifungals in clinical such as Amphotericin B, Itraconazole, and 5-fluorocytosine were also sensitive to Fungi.6. However, for the gram-positvie cocci, the susceptibility of most antibiotics such as Vancomycin, Rifampin and Gentamicin were decreased significantly, while this feature was not obviously in the gram-negative bacillus.7. Therefore, continuous surveillance of multiple centers are needed to monitor the changing of the pathogens and their antibiotics susceptibility in this region. |
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