Abstract
BackgroundThe objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975.MethodsObservational epidemiological, retrospective study on infants 0–6 days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997–2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975.ResultsThe total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997–2007 to 0.9/1000 LB in 2008–2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997–2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987–1996 to 0.45/1000 live births 1997–2017 and all cases were within 72 h. The proportion of extremely preterm infants (< 28 weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72 h as commensal organisms started to emerge.ConclusionThere has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area.Key notesThis study is one of the longest running follow-ups in the world, a follow-up of 43 years of early-onset neonatal infections.The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports.No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72 h or 7 days of life.
Highlights
The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017
Within a week after birth, from whom a pathogenic organism was isolated from blood or cerebrospinal fluid (CSF) during the years 1997–2017 were included in the study
The three most common organisms isolated from culture were Group B Streptococcus (GBS) (40%), S. aureus (16%) and E. coli (9%), (Table 2)
Summary
The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. Early-onset (EO) neonatal infections is a major cause of mortality and morbidity [1]. Group B Streptococcus (GBS) remains as one of the most common pathogen even though targeted interventions like intrapartum antimicrobial prophylaxis (IAP) have shown a significant reduction in the incidence of EO GBS infection [2,3,4,5]. A risk factor-based approach for identifying candidates for IAP was published in Sweden 2008 and is the current policy in Sweden [6]. Do not present with any risk factors and in many other countries the strategy for IAP is based on prenatal screening of GBS in late pregnancy instead [3, 7, 8]. Many international reports use the definition of EO infection being within 72 h after birth, whereas in studies on EO GBS the definition is often within the first week of life [2, 9,10,11]
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