Clinical features and outcomes of community‐acquired late‐onset sepsis: Focusing on group B Streptococcus and Escherichia coli

Abstract

Group B Streptococcus (GBS) and Escherichia coli are leading causes of late-onset sepsis (LOS) and bacterial meningitis in neonates and infants. This study aimed to describe clinical characteristics and outcomes of community-acquired (CA) LOS caused by GBS and E.coli. A retrospective observational study was performed in three university hospitals in Korea. All infants aged <90days who were diagnosed with GBS or Ecoli CA-LOS from 2011 to 2017 were enrolled. Data on the clinical characteristics and outcomes of GBS and E.coli CA-LOS were compared. Forty GBS and 43 E.coli CA-LOS cases were identified, which mostly (82/83) included term or near-term infants. Meningitis was identified in 54.1% of GBS CA-LOS cases and in 30.3% of E.coli CA-LOS cases, and 88.4% of E.coli CA-LOS cases involved urosepsis. Ten percent each of GBS and non-uropathogenic E.coli (non-UPEC) meningitis cases and all uropathogenic E. coli (UPEC) meningitis cases were diagnosed by pleocytosis without bacterial growth in the cerebrospinal fluid (CSF). Patients with non-culture-proven meningitis had lower CSF pleocytosis and protein levels and higher CSF/serum glucose ratios than patients with culture-proven meningitis (P<0.05 for all). One patient died of CA-LOS, which was accompanied by meningitis with extended-spectrum β-lactamase-producing non-UPEC. Neurological complications developed in 22.5% of GBS CA-LOS cases and in 2.3% of E.coli CA-LOS cases. Neurological complications were frequently observed in GBS CA-LOS cases, although no mortality was observed. Escherichia coli CA-LOS generally developed as urosepsis, which caused non-culture-proven meningitis and had a favorable outcome.