Antibiotic Susceptibility of <i>Escherichia coli</i> Among Infants Admitted to Neonatal Intensive Care Units Across the US From 2009 to 2017

Flannery, Dustin D.; Akinboyo, Ibukunoluwa; Mukhopadhyay, Sagori; Tribble, Alison C.; Song, Lihai; Chen, Feiyan; Li, Yun; Gerber, Jeffrey S.; Puopolo, Karen M.

doi:10.1001/jamapediatrics.2020.4719

Cited by 43 publications

(41 citation statements)

References 40 publications

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“…Although numbers are small, the Gram-negative antibiotic nonsusceptibility rate, remained unchanged. This is comparable to a recent study, from the USA where they found a stable E. coli nonsusceptibility rate during 2009–2017 ( 10 ). The nonsusceptibility rates were on the other hand substantially higher than in our study.…”

Section: Discussionsupporting

confidence: 90%

“…The median (IQR) duration of antibiotic therapy for EOS declined from 14 (10)(11)(12)(13)(14) days in the period 1996-2006 compared to 8 (7-10) days in the period 2007-2018 (p < 0.013).…”

Section: Antibiotic Therapy and Susceptibilitymentioning

confidence: 96%

“…There is growing concern about increasing antibiotic nonsusceptibility among pathogens causing EOS, especially in Gram-negative pathogens where often few therapeutic options are available (10). Increasing nonsusceptibility rates, could potentially threaten the effectiveness of standard empiric regimens (5,(10)(11)(12). In the action plan to combat antibiotic resistance, the World Health Organization calls for increased knowledge on local epidemiology and antibiotic susceptibility patterns (9).…”

Section: Introductionmentioning

confidence: 99%

“…However, data on antibiotic susceptibility is often not reported in epidemiological studies. There is growing concern about increasing antibiotic nonsusceptibility among pathogens causing EOS, especially in Gram-negative pathogens where often few therapeutic options are available ( 10 ). Increasing nonsusceptibility rates, could potentially threaten the effectiveness of standard empiric regimens ( 5 , 10 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Early-Onset Sepsis in Neonates - A Population-Based Study in South-West Norway From 1996 to 2018

et al. 2021

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Background: The epidemiology of early-onset sepsis (EOS) may change over time. Longitudinal surveillance of causative pathogens, antibiotic susceptibility patterns and antibiotic therapy is important for optimal therapy strategies.Objectives: To describe the incidence of culture-confirmed EOS, causative pathogens, antibiotic susceptibility patterns and antibiotic therapy over a 23-year period.Methods: Retrospective population-based study from a single-center neonatal intensive care unit at Stavanger University Hospital, Norway, covering a population in South-West Norway, during the 23-year period 1996–2018.Results: Of 104,377 live born infants, 101 infants (0.97/1,000) had culture-confirmed EOS; 89 with Gram positive and 12 with Gram-negative bacteria. The EOS-attributable mortality was 6/101 (5.8%). For the three most prevalent pathogens the incidences were; Group B streptococcus (GBS) 0.57/1,000, Escherichia coli 0.11/1,000 and viridans group streptococci (VGS) 0.10/1,000. GBS was the most common pathogen (59/93; 63%) in infants with gestational age (GA) ≥ 28 weeks. In contrast, among extremely preterm infants (GA <28 weeks) the incidence of E. coli infection was higher than for GBS infection. The second most common bacterial pathogens causing EOS among term infants were VGS. There was no change in the incidence of EOS for the entire study period, but from 2000 to 2018 there was a mean decline in EOS by 6% per year (95% CI 1%−10%) (p = 0.019). The incidences of GBS and E. coli did not change during the study period. The initial empirical antibiotic regimen for EOS was in all cases a combination of benzylpenicillin or ampicillin and an aminoglycoside, but in 21/101 (21%) of cases a broad-spectrum antibiotic was either added or substituted this regimen. In 2/101 (2%) EOS cases, the pathogens were nonsusceptible to the empirical antibiotic regimen. All E. coli isolates were susceptible to aminoglycosides.Conclusion: GBS was the most common causative pathogens in EOS, but E. coli dominated in infants with GA <28 weeks. There was no change in the incidence of EOS during the entire study period. The current empiric regimen with benzylpenicillin and gentamicin provides a very high coverage for EOS in our setting.

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Section: Discussionsupporting

confidence: 90%

“…The median (IQR) duration of antibiotic therapy for EOS declined from 14 (10)(11)(12)(13)(14) days in the period 1996-2006 compared to 8 (7-10) days in the period 2007-2018 (p < 0.013).…”

Section: Antibiotic Therapy and Susceptibilitymentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early-Onset Sepsis in Neonates - A Population-Based Study in South-West Norway From 1996 to 2018

et al. 2021

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“…The rate of antibiotic resistant bacteria in our study was low compared to studies from other settings [36,37]. In a recent retrospective study between 2009 and 2017 from the USA, a mean of 5% ESBL-producingE.coli was seen in a large cohort (n = 733) of neonatal E-coli sepsis [38]. The proportion of all ESBL-producingEnterobacterales in our study, with a smaller sample size, was 7/107 (6.5%) and is still considered low.…”

Section: Discussioncontrasting

confidence: 62%

A decade of neonatal sepsis caused by gram-negative bacilli—a retrospective matched cohort study

Nordberg

Iversen

Tidell

et al. 2021

Eur J Clin Microbiol Infect Dis

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This study is to determine the incidence and outcome of neonatal gram-negative bacilli (GNB) sepsis in Stockholm, Sweden, and describe bacterial characteristics. This is a retrospective cohort study. All infants with GNB-sepsis between 2006 and 2016 were included and matched with two control groups, with suspected sepsis and uninfected neonates, respectively. Outcome was death before discharge, risk of death within 5 days after sepsis onset, and morbidity. The resistance pattern from all GNB was collected, and all available isolates were subjected to genome typing. All neonates with GNB-sepsis (n = 107) were included, and the cumulative GNB-sepsis incidence was 0.35/1000 live born. The in-hospital mortality was 30/107 (28%). GNB late-onset sepsis (LOS) was associated with an increase in mortality before discharge compared to uninfected controls (OR = 3.9; CI 1.6–9.4) but not versus suspected sepsis. The suspected LOS cases did not statistically differ significantly from uninfected controls. The case fatality rate (CFR) at 5 days was 5/33 (15%) in GNB early-onset sepsis (EOS) and 25/74 (34%) in GNB-LOS. The adjusted hazard for 5 days CFR was higher in GNB-LOS versus uninfected controls (HR = 3.7; CI 1.2–11.2), but no significant difference was seen in GNB-LOS versus suspected sepsis or in suspected sepsis versus controls. ESBL production was seen in 7/107 (6.5%) of the GNB isolates. GNB-LOS was associated with a higher 5 days CFR and in-hospital mortality compared to uninfected controls but not versus suspect sepsis. The incidence of both GNB-EOS and GNB-LOS was lower than previously reported from comparable high-income settings. The occurrence of antibiotic resistance was low.

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Ampicillin and Gentamicin in Infants With Suspected Sepsis

Weissman

Stoll

2021

JAMA Pediatr

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Antibiotic Susceptibility of Escherichia coli Among Infants Admitted to Neonatal Intensive Care Units Across the US From 2009 to 2017

Cited by 43 publications

References 40 publications

Early-Onset Sepsis in Neonates - A Population-Based Study in South-West Norway From 1996 to 2018

Early-Onset Sepsis in Neonates - A Population-Based Study in South-West Norway From 1996 to 2018

A decade of neonatal sepsis caused by gram-negative bacilli—a retrospective matched cohort study

Ampicillin and Gentamicin in Infants With Suspected Sepsis

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