Long-Term Epidemiology of Neonatal Sepsis: Benefits and Concerns

Abstract

agulase-negative staphylococci (CoNS). CoNS are now appreciated as a world-wide cause of nosocomial infections in neonatal intensive care units (NICUs) [5] . In the future, longitudinal reviews of neonatal sepsis from the Wilhelmina Children’s Hospital may be informative to caregivers in other NICUs of Western Europe. Neonatal units in developed and developing countries outside Europe should probably not rely on the information about neonatal sepsis from studies performed at the Wilhelmina Children’s Hospital, other NICUs in Western Europe or the USA. Rather, it is recommended that all NICUs conduct their own surveillance of infections [6] . Knowledge of the antibiotic susceptibilities of pathogens causing EOS and LOS in a particular NICU assists clinicians in making decisions about empiric antibiotics before microbiologic studies are available [7] . This strategy may also reduce neonatal morbidity and mortality from infection [8] . van den Hoogen et al. [2] express opinions in their report that require discussion. Similar to treatment for LOS at the Wilhelmina Children’s Hospital, Karlowicz and associates [9] suggest vancomycin can be avoided as an empiric antibiotic for nosocomial infections. The rationale for use of a 1st-generation cephalosporin to treat LOS is based on the finding that deaths are rarely associated with CoNS infections [9] . Several issues must be considered when a caregiver selects a 1st-generation cephaloIn the United States of America (USA), a historical study of neonatal sepsis from Yale-New Haven Hospital has become a roadmap for health care professionals. In a recent 15-year period, the causes of neonatal sepsis at Yale were compared to the 60 years of preexisting data [1] . Publications related to neonatal sepsis at Yale have helped identify new or emerging bacterial pathogens that cause early-onset sepsis (EOS) and late-onset sepsis (LOS) in neonates. In this issue of Neonatology [2] , van den Hoogen and colleagues report the first long-term epidemiologic study of neonatal sepsis in Western Europe. The 29-year review of EOS and LOS at the Wilhelmina Children’s Hospital in the Netherlands shows trends like those seen at Yale with a few exceptions. First, these Dutch investigators show a reduction in EOS caused by group B streptococci after recent increased use of intrapartum antibiotics. A report from Yale had similar findings [3] . Second, van den Hoogen and colleagues found a low incidence of Gram-negative infections in neonates [2] , but a report from Yale observed a recent and substantial increase in EOS and LOS caused by Escherichia coli [4] . It is plausible that intrapartum use of antibiotics at the University Medical Centre in Utrecht will over time result in increased EOS and LOS caused by Gram-negative bacteria akin to those emerging at Yale [3, 4] . The primary cause of LOS at the Wilhelmina Children’s Hospital is currently coReceived: November 11, 2008 Accepted after revision: November 19, 2008 Published online: July 2, 2009 formerly Biology of the Neonate