Background and aims Gram-negative sepsis is associated with high morbidity and mortality in neonates and necessitates prompt treatment with appropriate antibiotics. This study focused on the epidemiology and antibiotic susceptibility of GN pathogens over the last 10 years using data from a neonatal infection network.
Methods neonIN is an international web-based surveillance database which captures culture proven neonatal infections. Data for UK neonatal-units (NNUs) on GN infection episodes between April 2004 and May 2014 were extracted. Late-onset sepsis (LOS) was defined as an episode occurring from 48-hours after birth.
Results There were 605 episodes from 28 NNUs (involving 540 neonates). Overall incidence was 0.87/1000 live-births and 7.10/1000 NNU-admissions. LOS accounted for the majority of all GN episodes (532, 87.9%) and was associated with an earlier gestation-age than early-onset sepsis (median 26 vs 30 weeks, p < 0.001). E. coli was the commonest pathogen (217, 35.9%) followed by Klebsiella sp. (120, 19.8%) and Enterobacter sp. (102, 16.9%). The pathogens were predominately isolated from blood (544, 89.9%). 74 (12.2%) episodes were treated as meningitis with no significant difference in meningitis rates between pathogens. Resistance data were available for 342 (56.5%) episodes. Resistance to 3rd-generation cephalosporins was 19.7% (36/183), to aminoglycosides 9.9% (29/291) and to quinolones 13.1% (23/175).
Conclusion GN infections represent a significant burden of infection in the hospitalised neonate. Rates of 3rd-generation cephalosporin resistance pose a challenge for their use as empiric therapy. Ongoing surveillance of antibiotic susceptibility is necessary to ensure optimal antibiotic practice.
On behalf of the Neonatal Infection Surveillance Network (neonIN).