Analysis Of Clinical Characteristics And Antibiotic Resistance Evolution In Neonatal Escherichia Coli Sepsis

Objective: This study aims to investigate the clinical features and the changes of antibiotic resistance of neonatal Escherichia coli sepsis,in order to provide help for early clinical detection and selection of empiric antibiotics.Methods: The clinical data of newborns with neonatal sepsis who were hospitalized in the Department of Neonatology in Children's Hospital of Chongqing Medical University from January 1,2012 to December 31,2019 was collected through a retrospective case-control study.Infants with Escherichia coli sepsis were selected as the test group,and infants with other bacterial pathogens sepsis as the control group.Results:(1)A total of 102 neonates with Escherichia coli sepsis that met the inclusion criteria and 153 patients with other pathogens were collected.Compared with the control group,neonates with Escherichia coli sepsis had a higher incidence of prematurity(32.4% vs 19.0%),very low birth weight(12.7% vs 5.2%),higher likelihood of early-onset sepsis(36.3% vs 24.2%),and a higher mortality(16.7% vs 8.5%).The differences were statistically significant(P <0.05).(2)Respiratory infection was the main route of infection in both groups.Compared with other pathogens group,the Escherichia coli group was more prone to seizures(18.6% vs 9.2%)and irritability(14.7% vs 6.5%);and had more significantly decreasing WBC(13.7% vs 5.9%),higher C-reactive protein and procalcitonin levels(43.5mg/L vs 17mg/L,4.3ng/mL vs 1.7ng/mL);and had higher likelihood of complications of bacterial meningitis,intracranial hemorrhage,hypoalbuminemia,and respiratory failure(44.1% vs 24.2%,19.6% vs 9.2%,37.2% vs 22.9%,22.5% vs 13.1%).The differences were statistically significant(P <0.05).(3)The antibiotic susceptibility testing of Escherichia coli showed that: beta-lactam antibiotics resistance rates were the highest(79.4% were ampicillin-resistant);except ceftazidime and cefepime,the resistance rates of other cephalosporins were also high(40.6%~57.4%);the rates of resistance to ?-lactamase inhibitor combinations(7%~33%)and carbapenems antibiotics(4.0%~4.1%)were low.Compared with the data in 2012-2015,the rate of E.coli producing Extended-spectrum ?-lactamases(ESBLs)increased significantly in 2016-2019(67.4% vs 40.0%),and the rate of overall resistance to third-generation cephalosporins increased gradually(60.4% vs 35.8%).The differences were statistically significant(P <0.05).Conclusion:(1)Compared with sepsis caused by other pathogens,neonatal Escherichia coli sepsis is more common in premature,early-onset sepsis and very low birth weight infants,and is more severe with a higher mortality.(2)The rate of positive ESBLs and the overall resistance to third-generation cephalosporins in Escherichia coli are both in an increasing trend over time.