Pattern of antimicrobial resistance in bloodstream isolates from Chinese neonates

Background: Antimicrobial resistance (AMR) is a major health threat in China. Very limited information is available on AMR rates in Chinese neonates, with data often published in local languages. Methods: We undertook a systematic review and the aims were to (i) review the AMR rates for bloodstream isolates from Chinese neonates and (ii) estimate the likely efficacy of first-line treatments for neonatal sepsis on selected pathogens. Medline, Embase, and the Chinese language only CNKI databases were systematically searched for papers published in 2000-2016 combining terms for “China” AND "Neonates" AND "Antimicrobial resistance" AND "Blood Culture". Studies published in English or Chinese reporting data on (i) blood culture isolates (ii) from neonates 0-28 days (iii) with AMR pattern were included. Results: A total of 108 studies were included, of which only two were published in English. Data on 16,739 isolates were analysed. Among Gram-positives, 60.5% of Staphylococcus aureus were oxacillin-resistant (MRSA). Among Gram-negatives, resistance to meropenem was around 7%, with resistance to 3rd-generation cephalosporins ranging between 50% and 70%. Very high rates of resistance to first-line Chinese and WHO empiric treatment guidelines for neonatal sepsis have been identified. Conclusion: A more complete assessment of current rates of antimicrobial resistance rates can be obtained by extending searches beyond English language data bases. There is an urgent need to develop alternative low cost empiric antibiotic regimens for neonatal sepsis