From the Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Integrated Medical Laboratory, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Pediatr Infect Dis J. 2024 Jan 1;43(1):56-62. doi: 10.1097/INF.0000000000004108. Epub 2023 Nov 16.
Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality in low- and middle-income countries. Blood culture positivity rates and antibiotic resistance pattern of neonatal sepsis differs across various regions. This study aims to identify clinical cofactors associated with blood culture-proven neonatal sepsis and in vitro resistance to first-line antibiotics (ampicillin and gentamicin) from cases originating in a tertiary healthcare center in Surabaya, Indonesia.
A retrospective cohort study was conducted from January 2020 to August 2022 by utilizing secondary data collected from standardized electronic medical records. Microbiologic characteristics and associated factors were statistically analyzed using multivariable logistic regression.
Across 266 neonatal sepsis cases, 46.9% were culture-proven and 79.2% of confirmed sepsis were resistant to first-line antibiotics. The most common isolated pathogen is Klebsiella pneumoniae , followed by coagulase-negative Staphylococci , Acinetobacter baumannii and Enterobacter cloacae . Extremely preterm delivery [adjusted odds ratio (aOR): 5.813; 95% confidence interval (CI): 1.70-19.91] and late-onset sepsis (aOR: 9.165; 95% CI: 5.12-16.40) were associated with culture-proven neonatal sepsis. Increased odds of resistance to first-line antibiotics were identified in extremely preterm (<28 weeks) or very-preterm delivery (28 to <32 weeks) (aOR: 50.80; 95% CI: 1.66-1554.21 and aOR: 45.679; 95% CI: 3.22-647.46, respectively), cesarean section (aOR: 4.149; 95% CI: 1.04-16.53) and an absence of antenatal corticosteroid use (aOR: 0.233; 95% CI: 0.07-0.76).
The association between clinical cofactors with culture-proven sepsis and antibiotic resistance emphasizes the importance for clinicians to adjust empirical antibiotic regimens based on the local antibiogram and resource availability.
新生儿败血症是中低收入国家导致新生儿发病率和死亡率的主要原因之一。不同地区的血培养阳性率和新生儿败血症的抗生素耐药模式存在差异。本研究旨在确定与印度尼西亚泗水一家三级保健中心的病例血培养证实的新生儿败血症和对一线抗生素（氨苄西林和庆大霉素）的体外耐药相关的临床合并症。
本回顾性队列研究于 2020 年 1 月至 2022 年 8 月期间进行，利用从标准化电子病历中收集的二级数据进行。使用多变量逻辑回归对微生物学特征和相关因素进行统计分析。
在 266 例新生儿败血症病例中，46.9%为培养阳性，79.2%的确诊败血症对一线抗生素耐药。最常见的分离病原体是肺炎克雷伯菌，其次是凝固酶阴性葡萄球菌、鲍曼不动杆菌和阴沟肠杆菌。极早产儿分娩（调整后的优势比[aOR]：5.813；95%置信区间[CI]：1.70-19.91）和晚发性败血症（aOR：9.165；95%CI：5.12-16.40）与血培养证实的新生儿败血症有关。极早产儿（<28 周）或非常早产儿（28 至<32 周）（aOR：50.80；95%CI：1.66-1554.21 和 aOR：45.679；95%CI：3.22-647.46）、剖宫产（aOR：4.149；95%CI：1.04-16.53）和未使用产前皮质激素（aOR：0.233；95%CI：0.07-0.76）与一线抗生素耐药的几率增加有关。
临床合并症与血培养证实的败血症和抗生素耐药之间的关联强调了临床医生根据当地抗生素图谱和资源可用性调整经验性抗生素治疗方案的重要性。
