Pathogenic characterization and drug resistance of neonatal sepsis in China: a systematic review and meta-analysis.

Objectives: Neonatal sepsis is one of the causes of neonatal mortality and bacterial resistance to antibiotics is one of the challenges facing NICU. The aim of this study was to provide a basis for empirical antibiotic selection by comprehensively searching Chinese and non-Chinese databases for studies related to neonatal sepsis pathogenesis conducted in China and synthesizing all the results of the studies conducted in hospitals in China during the period under study METHODS: In this study, we conducted extensive searches of Pubmed, Web of Science, Cochrane, China Biology Medicine disc (SinoMed), China National Knowledge Infrastructure (CNKI) and Wanfang Data. We screened studies published from 2014 to 2023 that were conducted in hospitals in mainland China and involved bacterial blood cultures and susceptibility tests in neonates with neonatal sepsis and extracted the data, which were summarized using Stata 18.0 software to determine the bacterial characteristics of NS and its antimicrobial resistance in China.

Results: A total of 97 articles were finally included in the study, involving 27 provinces, municipalities and autonomous regions, and a total of 18,796 bacterial strains were isolated. Among them, Gram-positive bacteria (G+) accounted for 63.4% (95% CI 59.6%~67.3% ), and Gram-negative bacteria (G-) accounted for 36.6% (95% CI 32.7%~40.4%). The most common bacteria were, in order, Coagulase-negative Staphylococcus (43.6%, 95% CI 37.9-49.3%), Enterobacter (16.4%, 95% CI 14.8-18.1%), and Klebsiella (12.4%, 95% CI 10.8-14.0%). More than 80% of G + were resistant to penicillin, ampicillin, and benzathine, and no strains resistant to minocycline or daptomycin were found. More than 80% of G- were resistant to benzoxicillin, ampicillin, and cefotaxime, and no strains resistant to vancomycin, clindamycin, tigecycline, teicoplanin, and linezolid were identified.

Conclusion: Coagulase-negative Staphylococcus is still the main causative agent for children with neonatal sepsis in China, followed by Enterobacter and Klebsiella. In addition, Group B Streptococcus is no longer in the top three common causative agents. Resistance to penicillin antibiotics is evident among the causative organisms of neonatal sepsis in China.