Abstract
The objective of the study was to assess the epidemiology of late-onset (LO) neonatal invasive infections with surveillance covering 43 years, starting from 1975. Observational epidemiologic, retrospective study including a cohort of infants born in western Sweden in 1997-2017, who had a positive blood and cerebral spinal fluid culture between 3 and 120 days of age. A comparison was made of the incidence between 1997-2007 and 2008-2017. Data on LO infections during 3-27 days of life were assessed from 1975. A total of 473 cases of LO infections were registered in 437 patients. The incidence increased from 2.0 to 3.1/1000 live births (LB) between 1997-2007 and 2008-2017 (P < 0.001). The increase in incidence was most pronounced among infants born <28 weeks gestation (from 255 to 398/1000 LB, P < 0.001). The most frequent pathogens were Staphylococcus aureus (25%), coagulase-negative staphylococci (17%), and Escherichia coli (13%). Infections due to group B Streptococci rose from 0.16/1000 LB to 0.33 (P = 0.03). During the whole surveillance period from 1975 to 2017, there were 579 cases between 3 and 27 days of life. Although the incidence increased in 2008-2017 to 1.9/1000 LB after first declining in 1997-2007, the case-fatality rate continued to decline from 27/284 (9.5%) between 1975 and 1996 to 6/182 (3.3%) in 2008 and 2017 (P = 0.01). The incidence of LO neonatal invasive infections increased during the study period (1997-2017), but the case-fatality rate remained lower than in the previous surveillance period (1975-1996). Further surveillance and interventions with focus on prevention is critical to counteract the increasing incidence among high-risk infants.
Highlights
IntroductionChildbed fever with high maternal mortality was a dreaded complication of childbirth, causing almost one-third of every woman to die of puerperal sepsis in the early 19th century
Infections at childbirth have been well known for centuries
These studies have shown that the incidence of EO infections has declined, but for LO infections, it has increased
Summary
Childbed fever with high maternal mortality was a dreaded complication of childbirth, causing almost one-third of every woman to die of puerperal sepsis in the early 19th century. Dr Semmelwis received much criticism from his colleagues and supervisors after introducing antiseptic techniques with handwash and chlorine solution to prevent the spread. His contribution to science was not accepted until after his death in 1865 [2]. Along with antiseptic techniques and potential lower virulence of the bacteria, cases of puerperal sepsis declined at the end of the 19th century [3]. Late-onset (LO) neonatal infections are, on the other hand, thought to be caused by horizontal transmission from the environment or gut after birth. LO-infection has been variably defined as an infection that occurs after day 3 to 7 of life and before day 28, 90, and 120 [10, 14,15,16,17,18,19]
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