Neonatal sepsis (NS) remains a major cause of morbidity and mortality in neonates, but data on the etiology and
antibiotic susceptibility patterns of pathogens are limited. The aim of this study was to analyze the clinical characteristics, risk factors, and the
antibiotic susceptibility patterns of pathogenic microbes associated with NS at a tertiary children's hospital in Shanghai, China.Episodes of blood culture-proven
sepsis in the neonatal intensive care unit (NICU) of Children's Hospital of Fudan University from January 2013 to August 2017 were retrospectively reviewed. Collected data included demographics, perinatal risk factors, clinical symptoms, laboratory values, microbiology results and their antimicrobial susceptibility. Data for early-onset
neonatal sepsis (EONS) and late-onset
neonatal sepsis (LONS) were compared.The 341 of 976 culture-positive cases were selected, including 161 EONS cases (47.21% of 341) and 180 LONS cases (52.79% of 341). 635 incomplete cases were excluded. There was significant difference in risk factors between the EONS group and LONS group including
birth weight, gestational age, 1-minute Apgar score, respiratory support, and the use of peripherally insertion central
catheter (PICC). Clinical symptoms such as
fever, feeding intolerance, abdominal distension, and
neonatal jaundice, and laboratory results such as
hemoglobin and lymphocyte counts also showed between-group differences. Staphylococcus epidermidis (22.87%), Escherichia coli (9.68%), Alcaligenes xylosoxidans (9.38%) and Klebsiella pneumoniae (9.09%) remain the principal organisms responsible for
neonatal sepsis. Most isolates of Gram-positive bacteria were sensitive to
vancomycin,
linezolid,
minocycline and
tigecycline, of which more than 90% were resistant to
penicillin. Most isolates of Gram-negative bacteria were sensitive to
amikacin and
imipenem and resistant to
ampicillin. Fungus was sensitive to
antifungal agents. Better medical decisions, especially early detection and appropriate initial antimicrobial
therapy can be made after understanding the different clinical features and pathogens of EONS and LONS.