Weijun Yan,* Jiahui Liang,* Minxue Liu, Xuehua Hu, Huan Zhang, Jing Guo, Linlin Li

Department of Clinical Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Linlin Li, Email lilinlin0810@126.com

Background: Neonatal bloodstream infections (BSIs) caused by extended-spectrum β-lactamase Enterobacterales (ESBL-E) are associated with high rates of morbidity and mortality. This study aimed to describe the clinical characteristics, profiles of antibiotic susceptibility, and risk factors associated with BSIs caused by E. coli (ESBL-EC) and K. pneumoniae (ESBL-KP), and identify risk factors for poor prognosis in neonatal patients with E. coli or K. pneumoniae BSIs.
Methods: In the period from January 2017 to December 2023, a retrospective case-control study was conducted at Guangxi Children’s Hospital in China. Demographic, clinical, and microbiological characteristics were collected. Antimicrobial resistance (AMR) profiles and clinical risk factors associated with ESBL-EC and ESBL-KP BSIs were systematically evaluated, along with independent predictors of poor prognosis in neonates with ESBL-EC or ESBL-KP BSIs.
Results: A total of 139 patients with E. coli and K. pneumoniae BSIs were enrolled, comprising 29 patients with ESBL-EC, 13 patients with ESBL KP, 10 patients with carbapenem-resistant K. pneumoniae (CRKP), and 87 patients with non-ESBL strains of BSIs. ESBL-EC and ESBL-KP demonstrated elevated resistance rates to the majority of clinically commonly used antibiotics. Late premature infant, very low birth weight, cesarean section, pneumonia, and mechanical ventilation were associated with the development of ESBL strains BSIs. Furthermore, very premature infants, extremely low birth weight, hypoalbuminemia, anemia, and isolation of CRKP were significantly correlated with a poor prognosis. Hypoalbuminemia (OR: 3.922, 95% CI: 1.189– 12.937, p=0.025) and the isolation of CRKP (OR: 11.548, 95% CI: 1.785– 74.708, p=0.010) were independent predictors of poor prognosis for E. coli and K. pneumoniae BSIs in neonatal patients.
Conclusion: Late premature infant, very low birth weight, cesarean section, pneumonia, and mechanical ventilation were associated with the development of ESBL strains BSI. More attention should be paid to ESBL strains causing BSI in the neonatal population.

Keywords: neonatal, BSI, risk factor, ESBL