Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis

Alarcon, Ana; Peña, Pilar; Salas, Sofía P; Sancha, Marta; Omeñaca, F

doi:10.1097/00006454-200404000-00004

Cited by 69 publications

(50 citation statements)

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“…Empirical treatment regimens for neonatal sepsis combine ampicillin with either an aminoglycoside or a cephalosporin of the cefotaxime-group. The proportion of ampicillin-resistance in this study was comparable to published data of resistance rates of 40% to 65% in E. coli EOS [3,4], whereas susceptibility to gentamicin and cefotaxime was shown to remain high throughout Germany. However, 3.8% of the strains proved to be resistant to the combination of ampicillin and gentamicin, and another 3.8% were resistant to the combination of ampicillin and cefotaxime.…”

Section: Discussionsupporting

confidence: 87%

“…. In E. coli, attention concerning antibiotic susceptibility mainly has been focused on the development of ampicillin-resistance in early onset sepsis (EOS) of preterm infants [3,4], whereas few studies have systematically examined susceptibility to other classes of antibiotics in neonatal sepsis. We present the first nationwide surveillance data on antibiotic susceptibility of neonatal invasive E. coli strains isolated in Germany.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009–2010

Heideking

Lander²,

Hufnagel

et al. 2013

Eur J Clin Microbiol Infect Dis

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009–2010

Heideking

Lander²,

Hufnagel

et al. 2013

Eur J Clin Microbiol Infect Dis

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“…Specifically, questions have been raised regarding whether IAP results in higher incidences of EOS attributable to organisms other than GBS and whether it is associated with changes in rates of EOS caused by ampicillin-resistant organisms, particularly in VLBW infants. 2,[17][18][19][20][21][22] Our study is the largest single-center study of exclusively inborn neonates to address these questions. We found that the overall incidence of neonatal EOS decreased in the era of GBS IAP, among all newborns and among VLBW infants.…”

Section: Discussionmentioning

confidence: 99%

No Change in the Incidence of Ampicillin-Resistant, Neonatal, Early-Onset Sepsis Over 18 Years

Puopolo

Eichenwald

2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:The incidence of neonatal EOS caused by GBS has decreased with widespread use of IAP. The overall impact of peripartum antibiotic treatment on the incidence and antibiotic resistance of other early-onset infections remains unclear. WHAT THIS STUDY ADDS:Despite increases in peripartum antibiotic exposure, neonatal EOS rates decreased for all infants, with no change in the incidence of ampicillin-resistant infections. These findings may be secondary to the use of penicillin G rather than ampicillin for GBS prophylaxis.abstract OBJECTIVE: The objective of this study was to assess the effect of maternal antibiotic exposure on neonatal early-onset sepsis (EOS) rates over an 18-year period. METHODS:A review was performed of infant and maternal records for all culture-proven cases of EOS in infants delivered at the Brigham and Women's Hospital (Boston, MA) in 1990 -2007. RESULTS:Data were analyzed from 335 EOS cases over periods that differed with respect to hospital policy for intrapartum antibiotic prophylaxis against group B Streptococcus (GBS) : 1990 -1992 (no prophylaxis); 1993-1996 (risk-based); and 1997-2007 (screening-based). The overall incidence of EOS decreased over these periods (3.70 vs 2.23 vs 1.59 cases per 1000 live births; P Ͻ .0001). No change in the incidence of infection with ampicillin-resistant organisms was observed overall or among very low birth weight infants. However, an increased proportion of infections were caused by ampicillin-resistant organisms. Mothers of infants with ampicillin-resistant infections were more likely to have been treated with ampicillin (P ϭ .0001). Overall peripartum antibiotic use increased during the study period primarily because of increased use of penicillin G and clindamycin, with no significant change in the use of ampicillin.CONCLUSIONS: Predominant use of penicillin G for GBS prophylaxis resulted in decreased incidence of EOS. No change in the incidence of ampicillin-resistant EOS was observed, but resistant cases were associated with peripartum ampicillin exposure. These findings suggest that obstetricians should consider preferential use of penicillin G for GBS prophylaxis. Pediatrics 2010;125:e1031-e1038

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“…8,9 The growing problem of antibiotic resistance may be a contributing factor in increasing mortality rates of infants with EONS. 2,10 These studies have identified an urgent need to better understand the changing epidemiology of EONS, to enable delivery of appropriate intrapartum care to mothers 8,11 and postnatal care of the newborns. We have therefore analyzed data from a large population of infants admitted to Canadian neonatal intensive care units (NICUs) between 2003 and 2008, to identify trends in EONS, and determine the distribution of organisms in infants with EONS.…”

Section: Introductionmentioning

confidence: 99%

Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008

et al. 2011

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Objective: Organisms causing early-onset neonatal sepsis (EONS) have consistently changed over time. The distribution of organisms in EONS helps to influence the appropriate type of antibiotic prophylaxis strategy during labor and the antibiotics used in neonates with suspected sepsis. Result: A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n ¼ 24969) in the earlier cohort compared with 6.2/1000 admissions (n ¼ 37484) in the later cohort (P ¼ 0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P ¼ 0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms. Conclusion:Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted. (2011) Introduction Early-onset neonatal sepsis (EONS) occurs within the first 3 to 7 days of life, and is thought to be mainly caused by vertical transmission of organisms from the mother. 1,2 The incidence of EONS has been reported to vary from 1 to 4.6 cases per 1000 live births. [2][3][4] Traditionally, prevention of EONS has focused on prevention of vertical transmission of group B Streptococcus (GBS or Streptococcus agalactiae) through administration of maternal intrapartum antibiotic prophylaxis. 5 No effective strategies are currently available to prevent EONS caused by other organisms, 6 such as Escherichia coli. 7 Several recent studies of patient populations in the US have reported a change in neonatal infection patterns, with a reduction in EONS caused by GBS but an increase in EONS caused by ampicillin-resistant E. coli. 8,9 The growing problem of antibiotic resistance may be a contributing factor in increasing mortality rates of infants with EONS. 2,10 These studies have identified an urgent need to better understand the changing epidemiology of EONS, to enable delivery of appropriate intrapartum care to mothers 8,11 and postnatal care of the newborns. We have therefore analyzed data from a large population of infants admitted to Canadian neonatal intensive care units (NICUs) between 2003 and 2008, to identify trends in EONS, and determine the distribution of organisms in infants with EONS. The objective of this study was to add to our understanding of changing patterns of organisms associated with EONS, thereby helping to strategize future interventions. Journal of Perinatology Methods Study populationThe Canadian Neonatal Network (CNN) maintains and updates an established neonata...

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Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis

Cited by 69 publications

References 20 publications

Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009–2010

Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009–2010

No Change in the Incidence of Ampicillin-Resistant, Neonatal, Early-Onset Sepsis Over 18 Years

Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008

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