OBJECTIVE: To evaluate the efficacy of sepsis risk calculator (SRC) in guiding antibiotic use in neonates with suspected early-onset sepsis (EOS). METHODS: A total of 284 neonates with a gestational age of ≥ 35 weeks were enrolled as the control group, who were hospitalized in the Children's Hospital of Chongqing Medical University from March to July, 2019 and were suspected of EOS. Their clinical data were retrospectively collected and the use of antibiotics was analyzed based on SRC. A total of 170 neonates with a gestational age of ≥ 35 weeks were enrolled as the study group, who were admitted to the hospital from July to November, 2020 and were suspected of EOS. SRC was used prospectively for risk scoring to assist the decision making of clinical antibiotic management. The two groups were compared in terms of the rate of use of antibiotics, blood culture test rate, clinical outcome, and adherence to the use of SRC. RESULTS: Compared with the control group, the study group had a significantly higher SRC score at birth and on admission ( CONCLUSIONS The use of SRC reduces the rate of empirical use of antibiotics in neonates with suspected EOS and does not increase the risk of adverse outcomes, and therefore, it holds promise for clinical application.
Anti-Bacterial Agents/therapeutic use* ; Child ; Humans ; Infant ; Infant, Newborn ; Neonatal Sepsis/drug therapy* ; Retrospective Studies ; Risk Assessment ; Sepsis/drug therapy*

OBJECTIVETo investigate the effects of antibiotic stewardship on the pathogen and clinical outcome of neonatal bloodstream infections (BSIs).

METHODSA retrospective study was performed on neonates with BSIs who were admitted to the neonatal ward in the years of 2010 (pre-stewardship) and 2013 (post-stewardship) for pathogens, antibiotic resistance, antibiotic use, and clinical outcomes.

RESULTSThe admission rate of BSIs (6.47% vs 2.78%) and the incidence of nosocomial BSIs (0.70% vs 0.30%) in 2013 were significantly higher than in 2010 (P<0.01). However, there were no signicant differences in the clinical outcomes between the years of 2010 and 2013 (P>0.05). The four most common pathogens isolated from blood cultures, Staphylococcus haemolyticus, Staphylococcus epidermidis, Klebsiella pneumoniae ssp pneumoniae and E.coli, were similar between the two years. There were no significant differences in the detection rates of extended spectrum β-lactamase-positve Klebsiella pneumoniae ssp pneumoniae or E.coli between the two years. The detection rates of methicillin-resistant Staphylococcus/β-lactamase-positive Staphylococcus haemolyticus and Staphylococcus epidermidis were similar between the two years (P>0.05).

CONCLUSIONSSince the implementation of antibiotic stewardship, there has been no marked variation in the common pathogens and their antibacterial resistance in neonatal BSIs. The antibiotic stewardship could promote the recovery of patients with BSIs.

Anti-Bacterial Agents ; therapeutic use ; Bacteria ; isolation & purification ; Drug Resistance, Microbial ; Humans ; Infant, Newborn ; Neonatal Sepsis ; drug therapy ; microbiology ; Retrospective Studies ; Time Factors

OBJECTIVETo realize the difference between China and France in the clinical manifestations, diagnosis and treatment of early-onset neonatal sepsis (EONS) and to provide basis to improve the level of our hospital in diagnosing and treating this disease.

METHODData of 146 cases of EONS were retrospectively analyzed. All data were collected from our hospital and a French hospital. Bacterial spectrum, clinical manifestations, use of antibacterial drugs, occurrence of recording and screening of perinatal risk factors were compared between the two hospitals.

RESULTThe most common pathogenic bacteria in our hospital were coagulase-negative staphylococcus (69.2%) and Escherichia coli (15.4%) while in the French Hospital, group B streptococcus (33.3%) and Escherichia coli (33.3%). The most common pathogenic bacteria in gastric liquid and peripheral swabs of the French hospital were Escherichia coli (33.3%) and group B streptococcus (21.2%). Total days of antibacterial use 11.4 ± 7.2 (d), mean sorts of antibacterial drugs for single patient (3.1 ± 0.9) and proportion of patients who had antibacterial drug changes (70.2%) were greater than the French hospital 6.2 ± 2.5 (d), 2.2 ± 0.8(d), (9.9%). Both hospitals were inclined to combine 2 antibacterial drugs for the first dose (second-generation cephalosporins + semi-synthetic penicillin in our hospital vs. amoxicillin + amikacin in the French hospital). The common second and third line antibacterial drugs in our hospital are carbapenems and vancomycin vs. third-generation cephalosporins and vancomycin in the French hospital. The rates of occurrence of recording and screening perinatal risk factors (chorioamnionitis, maternal fever, prolonged rupture of membranes, screening results of vaginal swabs or urinary infection, amniotic fluid contamination, prenatal antibacterial prophylaxis, anamnesis of EONS) in our hospital was all lower than those of the French hospital. There was no significant difference in positive rate of perinatal risk factors between the two hospitals. For newborns hospitalized for immediate abnormalities after birth, the most common symptom was respiratory distress (96.5% vs. 88.2%). For those admitted after a period of time after birth, the proportion of abnormalities was different: in our hospital, the most common reasons were respiratory distress (44.4%) and lethargy (22.2%) while in the French hospital there were rise of C reactive proteins (78.2%) and fever (5.5%). The false negative rate of C reactive proteins in diagnosing EONS was not significantly different between the two hospitals.

CONCLUSIONThere was significant difference in diagnosing and treating EONS in the two hospitals. Emphasis on screening and recording perinatal risk factors, as well as strengthened surveillance on neonates in obstetric department could improve the accuracy of early diagnosis of EONS of our hospital. Positive attitude to gastric liquid and peripheral swabs culture, with drug susceptibility test may help pediatricians better select antibacterial drugs and reduce unnecessary changes and the total time of antibiotic use.

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; C-Reactive Protein ; analysis ; China ; Drug Resistance, Microbial ; Escherichia coli ; drug effects ; isolation & purification ; Female ; France ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; drug therapy ; microbiology ; Male ; Microbial Sensitivity Tests ; Neonatal Screening ; methods ; Pregnancy ; Pregnancy Complications ; diagnosis ; Prenatal Diagnosis ; methods ; Retrospective Studies ; Risk Factors ; Sepsis ; diagnosis ; drug therapy ; microbiology ; Staphylococcus ; drug effects ; isolation & purification ; Streptococcus agalactiae ; drug effects ; isolation & purification

OBJECTIVETo analyze the clinical characteristics of Candida septicemia occurred in neonatal intensive care unit (NICU).

METHODSThe clinical characteristics of 9 confirmed cases with septicemia caused by Candida species yeasts were analyzed and summarized.

RESULTSAll the 9 cases were preterm infants, including 6 cases of very low birth weight infants. All these cases were treated with broad-spectrum antibiotics and parenteral nutrition before fungal infections occurred. Eight cases had percutaneous inserted central catheter (PICC). Three cases had been on ventilator. The symptoms of fungal infection were presented at 8 to 22 days of age. Apnea, poor perfusion and lethargy were common symptoms of these cases with fungal infection. Seven of the 9 cases developed thrombocytopenia. C reactive protein was elevated in 7 cases. Blood culture showed C. albicans in 1 case, C. parapsilosis in 2 cases, and C. guilliermondii in 6 cases. In 5 cases PICC culture showed the same fungus as blood culture revealed at the same time. All the 9 patients received antifungal therapy. Six patients were cured, two died and in one patient the treatments were given up by the parents.

CONCLUSIONSThe high risk factors of Candida septicemia in newborn infants include preterm, PICC, broad-spectrum antibiotic therapy and mechanical ventilation. The clinical presentations are always nonspecific. Thrombocytopenia and elevated C reactive protein are common in Candida septicemia patients. Early-started antifungal therapy can improve the prognosis.

Antifungal Agents ; therapeutic use ; C-Reactive Protein ; metabolism ; Candida ; drug effects ; isolation & purification ; pathogenicity ; Candidiasis ; physiopathology ; therapy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Male ; Prognosis ; Risk Factors ; Sepsis ; complications ; microbiology ; physiopathology ; therapy ; Thrombocytopenia ; microbiology ; Treatment Outcome