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Clinical Characteristics and Antimicrobial Resistance of Escherichia coli Bloodstream Infections in Neonates: A

Caifang Ma1, Zhenjia Liu2, Linlin Li1

  • 1Department of Clinical Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China.

Infection and Drug Resistance
|June 18, 2026
PubMed

Insights

Escherichia coli bloodstream infections (BSIs) in neonates differ from older children. Low albumin, total bile acid, and high direct bilirubin predict ICU admission risk in newborns with E. coli BSIs.

Area of Science:

  • Infectious Diseases
  • Neonatal Medicine
  • Clinical Microbiology

Background:

  • Escherichia coli (E. coli) bloodstream infections (BSIs) pose a significant global health challenge, particularly in vulnerable neonatal populations.
  • Understanding the unique clinical and microbiological aspects of E. coli BSIs in neonates is crucial for effective management and improved patient outcomes.

Purpose of the Study:

  • To investigate the clinical characteristics, laboratory indicators, treatment outcomes, and antimicrobial resistance patterns of E. coli BSIs in neonates.
  • To identify specific laboratory markers that predict the need for intensive care unit (ICU) admission in neonates with E. coli BSIs.

Main Methods:

  • A retrospective analysis of 179 patients with E. coli BSIs (91 neonates, 88 non-neonates) from January 2017 to December 2023.
  • Comparison of clinical parameters, laboratory results, and antimicrobial susceptibility between neonatal and non-neonatal groups.
  • Multivariable regression and ROC curve analysis to identify predictors of ICU admission in neonates.

Main Results:

  • Neonates with E. coli BSIs showed distinct resistance patterns, with high rates against ampicillin (83.52%), sulfamethoxazole (51.65%), and cefazolin (46.15%).
  • Non-neonates exhibited higher resistance to ceftazidime, imipenem, and meropenem compared to neonates.
  • Decreased albumin (ALB) and total bile acid (TBA), along with increased direct bilirubin (DBIL), were identified as independent risk factors for ICU admission in neonates.

Conclusions:

  • E. coli BSIs present unique clinical and resistance profiles in neonates versus older children.
  • Specific laboratory markers—low ALB (<33.06 g/L), low TBA (<8.2 μmol/L), and high DBIL (>14.64 μmol/L)—are significant predictors of ICU admission in neonates.
  • Monitoring these biomarkers can aid in early identification and management of high-risk neonates with E. coli BSIs, potentially improving outcomes.
Abstract

Keywords:
ICUantibioticfactorneonate

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