Rao Jingjing, Wang Xiaomei, Deng Shiyong, Tang Feng, Li Changzhen
Department of Laboratory Medicine, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital, Huazhong University of Science & Technology, Wuhan, 430015, People's Republic of China.
Eur J Clin Microbiol Infect Dis. 2025 Jan;44(1):117-127. doi: 10.1007/s10096-024-04992-8. Epub 2024 Nov 13.
To investigate the incidence, pathogen distribution, and antibiotic susceptibility of early- and late-onset neonatal bacteremia, and to analyze pathogen trends before and during the COVID-19 pandemic.
Between January 2016 to December 2022, we collected 879 blood and cerebrospinal fluid specimens from newborns with bacteremia. Bacterial identification used biochemical methods and MALDI-TOF, and antibiotic susceptibility was tested with the VITEK 2 system. Incidence per 1,000 admissions was calculated with Wilson's 95% confidence intervals, and categorical variables were compared using χ²-test or Fisher's exact test.
Early-onset bacteremia incidence was 2.6 per 1,000 admissions, and late-onset bacteremia was 26.3, with a significant decline from 70.7 to 10.5 per 1,000 admissions over the study period. Late-onset bacteremia was more common before COVID-19, while early-onset bacteremia increased during the pandemic. The top five pathogens were CoNS(39.9%), E. faecalis(17.7%), E. faecium(13.7%), E. coli(8.4%), and GBS(5.8%). During the COVID-19 pandemic, the incidence of CoNS and S. aureus infections significantly decreased. Throughout the entire study period, CoNS and S. aureus showed high resistance to penicillin G and erythromycin but were sensitive to vancomycin and linezolid. E. faecalis and E. faecium were susceptible to vancomycin, linezolid, and teicoplanin but resistant to erythromycin, tetracycline, and rifampin. MRCoNS and MRSA were detected in 72.7% and 31.0% of isolates, respectively. Resistance rates of E. faecium and E. faecalis to ampicillin decreased significantly, clindamycin resistance in GBS decreased during the pandemic.
This study highlights notable shifts in neonatal bacteraemia patterns during the COVID-19 Pandemic that were likely influenced by increased infection control and disruptions in maternal care, leading to changes in pathogen distribution and antimicrobial resistance.
调查早发型和晚发型新生儿菌血症的发病率、病原体分布及抗生素敏感性，并分析新冠疫情之前及期间的病原体变化趋势。
2016年1月至2022年12月期间，我们收集了879例菌血症新生儿的血液和脑脊液标本。采用生化方法和基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）进行细菌鉴定，并用VITEK 2系统检测抗生素敏感性。采用威尔逊95%置信区间计算每1000例入院病例中的发病率，分类变量采用χ²检验或Fisher精确检验进行比较。
早发型菌血症发病率为每1000例入院病例2.6例，晚发型菌血症为26.3例，在研究期间从每1000例入院病例70.7例显著下降至10.5例。晚发型菌血症在新冠疫情之前更为常见，而早发型菌血症在疫情期间有所增加。前五位病原体为凝固酶阴性葡萄球菌（CoNS，39.9%）、粪肠球菌（17.7%）、屎肠球菌（13.7%）、大肠埃希菌（8.4%）和B族链球菌（GBS，5.8%）。在新冠疫情期间，CoNS和金黄色葡萄球菌感染的发病率显著下降。在整个研究期间，CoNS和金黄色葡萄球菌对青霉素G和红霉素耐药，但对万古霉素和利奈唑胺敏感。粪肠球菌和屎肠球菌对万古霉素、利奈唑胺和替考拉宁敏感，但对红霉素、四环素和利福平耐药。分别在72.7%和31.0%的分离株中检测到耐甲氧西林CoNS（MRCoNS）和耐甲氧西林金黄色葡萄球菌（MRSA）。屎肠球菌和粪肠球菌对氨苄西林的耐药率显著下降，疫情期间GBS对克林霉素的耐药率下降。
本研究突出了新冠疫情期间新生儿菌血症模式的显著变化，这些变化可能受到感染控制加强和孕产妇护理中断的影响，导致病原体分布和抗菌药物耐药性发生改变。
