Intrapartum Antibiotic Prophylaxis Increases the Incidence of Gram-Negative Neonatal Sepsis

Abstract

Published guidelines have encouraged physicians to increase the use of intrapartum chemoprophylaxis to reduce vertical transmission of GBS. This study confirms the efficacy of this approach. Unfortunately, this reduction comes at the cost of increasing the incidence of ampicillin-resistant gram-negative neonatal sepsis with a resultant increased mortality. These data provide compelling evidence that the policy of providing ampicillin chemoprophylaxis in selected patients needs to be reconsidered.

The impact of group B Streptococcus prophylaxis on early onset neonatal infections

“…However, these findings contrast with earlier studies demonstrating a significant increase in the incidence of E. coli early onset sepsis among VLBW infants [19][20][21], as well as other studies demonstrating a significant increase in the incidence of early onset Gram-negative sepsis overall [17,18]. One possible reason for this discrepancy may be varying sample sizes across studies.…”

“…To control for bias of urinary tract infections alone, a secondary analysis was performed without urine cultures, yielding similar percentages. Studies have shown mortality rates as high as 40% [19][20][21] and suggest increased mortality rates depend on the causative pathogen [17,24] or antibiotic resistant pathogens [22,25,31]. Antibiotic resistance was not shown in logistic regression analysis to be a predictor of mortality or common morbidities.…”

“…Multiple studies found an increased incidence of early onset infections with Gram-negative bacteria, specifically Escherichia coli (E. coli) [17][18][19][20][21], and an increased incidence of antibiotic resistant E. coli infections [21][22][23][24][25]. These findings, however, seemed to be specific to the preterm or very low-birthweight (VLBW) populations [19][20][21][22][23] and are not consistent across studies.…”

Multidrug resistant neonatal sepsis in Peshawar, Pakistan

“…The routine use of intrapartum antibiotic prophylaxis for the prevention of group B streptococcus septicaemia in newborn babies has resulted in the appearance of ampicillin resistant Gram negative neonatal sepsis in a large number of developed countries. [26][27][28] Antibiotic resistance is increasing world wide and has become a serious health problem in hospitals and the community. Infection with resistant organisms has been associated with treatment failure, higher morbidity and mortality, and increased costs.…”

Extended-spectrum β-lactamase-producing pathogens in a children's hospital: A 5-year experience

“…1–3 In young infants, Gram-negative organisms are now the most common cause of serious bacterial infection. 4–6…”