Background: The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China.
Methods: All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth.
Results: Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks' gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity.
Conclusions: There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.