Cases Of Early-onset Neonatal Sepsis Research Articles

A rare case of early-onset neonatal sepsis caused by Proteus mirabilis in the first infant of tetrachorionic triamniotic triplets

Early-onset neonatal sepsis (EОNS) is one of the most severe diseases of the neonatal period and is often coupled to extremely unfavorable outcomes. In many ways, the severity of the condition and the results of newborn nursing depend on the etiology of the bacterial process. The major EОNS pathogens are traditionally considered to be Streptococcus group B and E. coli, much less common are other Gram-negative bacteria including casuistic cases caused by caused by Proteus mirabilis (P. mirabilis). The article provides a review on the P. mirabilis role in developing neonatal sepsis with pathogen-specific disease course and outcomes. In addition, we describe a clinical case of P. mirabilis-caused EОNS not only primarily characterized by the rarity of its causative agent, but also that it proceeded with a more favorable brain damage in contrast to similar cases described worldwide and because the neonatal EОNS developed in one of triplets, with two other babies being asymptomatic despite that P. mirabilis was also detected.

Use of the "Sepsis Risk Calculator" in Belgian Newborns: A Retrospective Cohort Study.

Prevention of early-onset neonatal sepsis (EONS) is a frequent reason why many newborns receive unnecessary antibiotics. The Sepsis Risk Calculator (SRC) was developed by the Kaiser Permanente Institute as a multivariate risk assessment of EONS, aiming to reduce laboratory testing and empiric neonatal antibiotic therapy. Our objective was to assess the potential of the SRC in reducing antibiotic use in our setting. Late preterm and term newborns who received antibiotics from 2019 to 2020 in a tertiary Belgian hospital were included. Newborn-specific data were collected and entered into the online SRC, retrospectively calculating a sepsis risk score and providing recommendations for antibiotic administration. False-positive indications for treatment by the SRC were estimated based on previously published data. Antibiotic therapy rates according to the SRC recommendations were compared to the actual rate of antibiotic therapy. Of 5891 births, 414 newborns received antibiotics and were eligible for this study, representing a rate of 7.6% of newborns receiving antibiotics following our current guidelines. The SRC would have recommended antibiotic administration for 2.7%, reducing antibiotic therapy by 64.5%. Of 5 possible cases of EONS, 3 would have received antibiotics in the first 24 hours according to the SRC. In this Belgian cohort, use of the SRC has the potential to significantly decrease by 64.5% the newborns that receive antibiotics. This reduction would primarily concern asymptomatic newborns. If use of the SRC was to be implemented in Belgian maternities, strict clinical surveillance practices should be ensured.

Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation

ObjectiveTo evaluate the efficiency of the sepsis risk calculator and the serial clinical observation in the management of late preterm and term newborns with infectious risk factors. MethodSingle-center, observational, two-phase cohort study comparing the rates of neonates born ≥35 weeks' gestation, ≥2000 g birthweight, and without major congenital anomalies, who were screened and/or received antibiotics for early-onset neonatal sepsis risk at our center during two periods, before (January/2018–June/2019) and after (July/2019–December/2020) the implementation of the sepsis risk calculator. ResultsA total of 1796 (Period 1) and 1867 (Period 2) patients with infectious risk factors were included. During the second period, tests to rule out sepsis were reduced by 34.0 % (RR, 95 %CI): 0.66 (0.61, 0.71), blood cultures by 13.1 %: 0.87 (0.77, 0.98), hospital admissions by 13.5 %: 0.86 (0.76, 0.98) and antibiotic administration by 45.9 %: 0.54 (0.47, 0.63). Three cases of early-onset neonatal sepsis occurred in the first period and two in the second. Clinical serial evaluation would have detected all true cases. ConclusionsThe implementation of a sepsis risk calculator in the management of newborns ≥35 weeks GA, ≥2000 g birthweight, without major congenital anomalies, with infectious risk factors is safe and adequate to reduce laboratory tests, blood cultures, hospital admissions, and antibiotics administration. Serial clinical observation, in addition, could be instrumental to achieve or even improve this goal.

Vaginal and neonatal microbiota in pregnant women with preterm premature rupture of membranes and consecutive early onset neonatal sepsis

BackgroundPreterm premature rupture of membranes (PPROM), which is associated with vaginal dysbiosis, is responsible for up to one-third of all preterm births. Consecutive ascending colonization, infection, and inflammation may lead to relevant neonatal morbidity including early-onset neonatal sepsis (EONS). The present study aims to assess the vaginal microbial composition of PPROM patients and its development under standard antibiotic therapy and to evaluate the usefulness of the vaginal microbiota for the prediction of EONS. It moreover aims to decipher neonatal microbiota at birth as possible mirror of the in utero microbiota.MethodsAs part of the PEONS prospective multicenter cohort study, 78 women with PPROM and their 89 neonates were recruited. Maternal vaginal and neonatal pharyngeal, rectal, umbilical cord blood, and meconium microbiota were analyzed by 16S rRNA gene sequencing. Significant differences between the sample groups were evaluated using permutational multivariate analysis of variance and differently distributed taxa by the Mann–Whitney test. Potential biomarkers for the prediction of EONS were analyzed using the MetaboAnalyst platform.ResultsVaginal microbiota at admission after PPROM were dominated by Lactobacillus spp. Standard antibiotic treatment triggers significant changes in microbial community (relative depletion of Lactobacillus spp. and relative enrichment of Ureaplasma parvum) accompanied by an increase in bacterial diversity, evenness and richness. The neonatal microbiota showed a heterogeneous microbial composition where meconium samples were characterized by specific taxa enriched in this niche. The vaginal microbiota at birth was shown to have the potential to predict EONS with Escherichia/Shigella and Facklamia as risk taxa and Anaerococcus obesiensis and Campylobacter ureolyticus as protective taxa. EONS cases could also be predicted at a reasonable rate from neonatal meconium communities with the protective taxa Bifidobacterium longum, Agathobacter rectale, and S. epidermidis as features.ConclusionsVaginal and neonatal microbiota analysis by 16S rRNA gene sequencing after PPROM may form the basis of individualized risk assessment for consecutive EONS. Further studies on extended cohorts are necessary to evaluate how far this technique may in future close a diagnostic gap to optimize and personalize the clinical management of PPROM patients.Trial registrationNCT03819192, ClinicalTrials.gov. Registered on January 28, 2019.

Streptococcus pneumoniae - an uncommon cause of neonatal sepsis: two case reports

Streptococcus pneumoniae is a rare but recognized aetiological agent for neonatal sepsis. In the context of scarce local data, we report two cases of early-onset neonatal sepsis (EONS) due to pneumococci that probably occurred following ascending transmission during the perinatal period.

1167. Hospital Readmissions among Infants Diagnosed with Early-Onset Neonatal Sepsis in Connecticut

BackgroundEarly-onset neonatal sepsis, defined as sepsis within 72 hours of birth, results in significant infant morbidity and mortality. Readmissions associated with neonatal sepsis have not previously been well-described. Early-onset neonatal sepsis is a mandatory reportable condition in Connecticut, allowing for expanded data collection through public health surveillance to evaluate readmissions. MethodsInfants with early-onset neonatal sepsis born in Connecticut during 2007–2016 were identified from statewide surveillance data and matched with a statewide hospital discharge database. We describe readmission rates, causes and timing of readmissions, and demographic and clinical factors associated with readmission among this group.ResultsAmong 250 infants with early-onset neonatal sepsis matched to discharge data, 208 (82%) infants survived their initial hospitalization at birth. During the first year of life, 49 (23.6%) infants were readmitted. The most frequent reasons for readmissions were pulmonary complications (19%), systemic symptoms (17%), and gastrointestinal illness (13%). Infants with initial hospitalizations lasting longer than 30 days after birth were associated with higher rates of readmission compared to those discharged within 30 days after birth (35% vs. 19%, p=0.02). Higher readmission rates were observed among non-white infants (29% vs. 18%, p=0.06). Summary of early-onset neonatal sepsis cases and return hospital visits in Connecticut, 2007-2016 Demographic and clinical factors for Connecticut neonatal sepsis cases, 2007-2016 Reason for one-year readmissions of Connecticut neonatal sepsis cases, 2007-2016 The top three reasons for readmission include pulmonary (19%), systemic (17%), and GI problems (13%).ConclusionGiven the high proportion of infants diagnosed with early-onset neonatal sepsis who are readmitted within the first year of life, further efforts are needed to prevent readmissions among this vulnerable patient population. Non-white infants and infants with prolonged initial hospitalizations after birth might be at higher risk for readmission. These groups warrant intensified strategies to prevent readmission.Disclosures Vivian Leung, MD, Nothing to disclose

Differential impact of abnormal vaginal colonization on perinatal outcome and association with early-onset neonatal sepsis: preterm labor vs. preterm premature rupture of membrane

Objective The purpose of this study was to check whether the impact of abnormal vaginal colonization on perinatal outcomes would be different in patients with preterm labor (PTL) and premature membrane rupture (PPROM). We also sought to determine the concordance rate of microorganisms isolated from the maternal vagina and neonatal blood in cases of early-onset neonatal sepsis (EONS) in PTL and PPROM. Methods This retrospective study included 996 singleton pregnancies who were admitted to the high risk care unit of our institution due to PTL (n = 519) or PPROM (n = 477) and underwent vaginal culture examination at admission between January 2005 and April 2019. Abnormal vaginal colonization was defined upon isolation of aerobic microorganisms. The maternal baseline characteristics, delivery, and neonatal outcomes were compared according to the presence or absence of abnormal vaginal flora, both in PTL and PPROM. Results The rate of abnormal vaginal colonization in PTL and PPROM was 17.0 and 21.4%, respectively. Both in PTL and PPROM, the gestational age at admission was lower in the abnormal vaginal colonization group (PTL, 27.2 ± 3.5 vs. 28.2 ± 3.5 weeks, p = .024; PPROM, 26.1 ± 5.3 vs. 27.5 ± 4.5 weeks, p = .007). Multivariable analysis demonstrated that the group with abnormal bacteria in PPROM but not in PTL had a significantly higher rate of EONS than the group without abnormal bacteria after adjustment for confounders including gestational age at admission (PPROM, odds ratio, OR [95% confidence interval, CI]: 4.172 [1.426–12.206]; PTL, OR [95% CI]: 0.661 [0.079–5.505]). Concordance analysis showed that the maternal vaginal bacteria colonization by Escherichia coli (5.9 vs. 0.5%, p = .033) and Staphylococcus aureus (14.3 vs. 0.2%, p = .032) in PPROM was significantly correlated with the microorganisms from the neonatal blood culture EONS cases. In PTL, no specific microorganisms showed concordance between maternal vaginal bacteria and microorganisms causing EONS. Conclusion Our data showed that maternal vaginal colonization in PPROM, but not in PTL, is an independent risk factor for EONS.

Managing Escherichia coli sepsis and the Tarragona strategy

Early onset sepsis is one of the leading causes of neonatal death – worldwide as well as in high-resource countries (1). The incidence (2) of early-onset sepsis and the case fatality rate (3) are even higher among preterm infants, in whom a shift towards gram-negative bacteria, predominantly Escherichia coli, occurs (4). For life-threatening diseases, empiric antibiotic therapy regimens must cover the most relevant pathogens and, at the same time, avoid any unnecessary use of reserve antibiotics (5, 6). In most cases of early-onset neonatal sepsis, the pathogens colonizing the neonate or its previous environment, the mother’s womb, are not known when treatment is initiated.

Early-onset neonatal sepsis: Organism patterns between 2009 and 2014.

ObjectiveTo evaluate trends in organisms causing early-onset neonatal sepsis (EONS). Congruent with recent reports, we hypothesized there would be an increase in EONS caused by Escherichia coli.Study DesignNational data on infants admitted to neonatal intensive care units from 2009 to 2014 were compared to previously reported data from 2003 to 2008. We report 430 cases of EONS from 2009 to 2014. Bivariate analyses were used to analyze the distribution of causative organisms over time and differences by gestational age. Linear regression was used to estimate trends in causative organisms.ResultsSince 2003, there has been a trend of increasing numbers of cases caused by E coli (P<0.01). The predominant organism was E coli in preterm infants and Group B Streptococcus in term infants.ConclusionsWith the majority of EONS cases now caused by E coli, our findings emphasize the importance of continued surveillance of causative organism patterns and developing approaches to reduce cases caused by E coli.

Early-Onset Neonatal Pneumococcal Infection

Abstract Streptococcus pneumoniae (SP) is a major cause of morbidity in childhood but has accounted for only a few reported cases of early-onset neonatal sepsis. Over the past decade, there have been increasing reports of early-onset neonatal sepsis due to SP associated with fulminant systemic disease and high mortality rates. Simultaneous maternal and neonatal sepsis with SP is relatively unusual. The literature reports rare cases of vaginal carriage and/or endometritis with this organism resulting in neonatal sepsis. We present a case of neonatal pneumococcal serotype 1 sepsis and cellulitis occurring concurrently with puerperal pneumococcal bacteremia. A male neonate was born at 38 weeks' gestation after a normal pregnancy. Although he was administered the appropriate antibiotics, the baby developed nape cellulitis and sepsis on the second day of life with SP that progressed to abscess formation requiring surgical drainage. The mother simultaneously developed pneumococcal bacteremia and endometritis 2 hours after delivery. Blood culture isolates from the mother and child were both serogroup 1. Transmission to the neonate may have been ascending or hematogenous. In addition, we summarize the neonate and maternal characteristics, clinical courses, and outcomes of published case reports of early-onset neonatal pneumococcal sepsis in the peer-reviewed literature. Our case highlights the need to consider SP as a cause of neonatal sepsis that can mimic early-onset group B streptococcal infection. Recognition of resistant strains in cases of bacteremia and meningitis is critical, and should be considered in choice of antibiotic therapy. Enhanced surveillance for the maternal carriage of SP and invasive pneumococcal disease during the neonatal period would help to define the epidemiology.

Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017.

Neonatal sepsis (NS) remains a major cause of morbidity and mortality in neonates, but data on the etiology and antibiotic susceptibility patterns of pathogens are limited. The aim of this study was to analyze the clinical characteristics, risk factors, and the antibiotic susceptibility patterns of pathogenic microbes associated with NS at a tertiary children's hospital in Shanghai, China.Episodes of blood culture-proven sepsis in the neonatal intensive care unit (NICU) of Children's Hospital of Fudan University from January 2013 to August 2017 were retrospectively reviewed. Collected data included demographics, perinatal risk factors, clinical symptoms, laboratory values, microbiology results and their antimicrobial susceptibility. Data for early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) were compared.The 341 of 976 culture-positive cases were selected, including 161 EONS cases (47.21% of 341) and 180 LONS cases (52.79% of 341). 635 incomplete cases were excluded. There was significant difference in risk factors between the EONS group and LONS group including birth weight, gestational age, 1-minute Apgar score, respiratory support, and the use of peripherally insertion central catheter (PICC). Clinical symptoms such as fever, feeding intolerance, abdominal distension, and neonatal jaundice, and laboratory results such as hemoglobin and lymphocyte counts also showed between-group differences. Staphylococcus epidermidis (22.87%), Escherichia coli (9.68%), Alcaligenes xylosoxidans (9.38%) and Klebsiella pneumoniae (9.09%) remain the principal organisms responsible for neonatal sepsis. Most isolates of Gram-positive bacteria were sensitive to vancomycin, linezolid, minocycline and tigecycline, of which more than 90% were resistant to penicillin. Most isolates of Gram-negative bacteria were sensitive to amikacin and imipenem and resistant to ampicillin. Fungus was sensitive to antifungal agents. Better medical decisions, especially early detection and appropriate initial antimicrobial therapy can be made after understanding the different clinical features and pathogens of EONS and LONS.

Population-based study of early-onset neonatal sepsis in Canada.

To determine the incidence, types of organisms and resistance patterns involved in early-onset neonatal sepsis in Canada. Early-onset neonatal sepsis cases were identified through the Canadian Paediatric Surveillance Program. Neonates were excluded if they were asymptomatic or if intracranial procedures preceded a positive cerebrospinal fluid culture. One hundred and twenty-seven cases were identified (0.17 cases per 1000 live births). Group B Streptococcus accounted for 41.7%, Escherichia coli for 35.4%. Antibiotic resistance was present in 33.9% of all cases. 55.6% of E coli cases were resistant, most commonly to ampicillin. Infecting organism species were associated with gestational age, being very low birth weight, time at sepsis presentation, maternal antibiotic prophylaxis and rupture of membranes lasting over 18 hours. Group B Streptococcus was most common in term and E coli in preterm neonates. Twenty-two per cent of E coli cases presented after 48 hours, compared to 6% of Group B Streptococcus cases. We identify a lower rate of early-onset neonatal sepsis than historically suggested, with differing dominant organisms based on gestational ages and other factors, as well as high rates of resistance especially among E coli cases.

Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth

To re-evaluate the utility of the conventional criteria for clinical chorioamnionitis in the prediction of early-onset neonatal sepsis (EONS) in preterm birth. Retrospective cohort study. Seoul, Republic of Korea. A total of 1468 singleton births between 24 and 34weeks due to preterm labour (n=713) or preterm prelabour rupture of membranes (n=755). We evaluated three diagnostic categories of clinical chorioamnionitis: Criteria 1, conventional criteria; Criteria 2, combination of any three conventional parameters without prerequisite fever; Criteria 3, Criteria 1 plus positive maternal C-reactive protein and neutrophil left-shift into minor criteria. EONS included proven or suspected sepsis within 7days following birth. Neonatal morbidity and mortality of EONS were also reviewed. Diagnostic performance of three combinations. The prevalence of EONS was 13.8%. Among 203 cases of EONS, maternal manifestation of clinical chorioamnionitis by criteria 1 was evident in only one out of seven, indicating 15.3% sensitivity for EONS prediction. However, with application of criteria 2, sensitivity significantly increased to 34.0%, while compromising specificity from 92.3% to 78.7%. Criteria 3 showed similar diagnostic performance compared with criteria 1 (sensitivity 16.7%, specificity 91.6%). Overall, neonatal mortality and neonatal composite morbidity in EONS were 14.9% and 67.8%, respectively, and there was no difference in neonatal morbidity and mortality between neonates whose mothers showed fever as a sign of clinical chorioamnionitis and those whose mothers did not. The renouncement of fever as a prerequisite for the criteria of clinical chorioamnionitis could increase sensitivity for the identification of EONS, a serious outcome of preterm birth. The renouncement of fever as an essential can increase sensitivity for prediction of neonatal sepsis.

Early Onset Neonatal Sepsis in Canada: 2011-2012

Abstract BACKGROUND: Canadian and US studies suggest that the organisms responsible for early-onset neonatal sepsis (EONS) are changing, with an increase in Escherichia coli (EC) as well as antibiotic-resistant organisms. Current Canadian guidelines for prevention and treatment of EONS are based on Group B streptococcus (GBS) as the likely organism. Population-level data may inform updates to these national strategies. OBJECTIVES: To determine the incidence, types of organisms and corresponding resistance patterns involved in EONS in Canada. To identify how the organisms are affected by maternal antibiotic prophylaxis and other factors. DESIGN/METHODS: Cases of EONS (defined as positive blood and/or cerebrospinal fluid (CSF) culture at &amp;lt;7 days of age) between January 2011 and December 2012 were identified through the Canadian Paediatric Surveillance Program (CPSP). Neonates were excluded if they were asymptomatic with a positive culture likely to be a contaminant, or if the CSF culture was positive as a result of an intracranial procedure. RESULTS: Over the 2-year period, 127 cases meeting our criteria were identified, and there were 754,849 total Canadian live births. The incidence for EONS was 0.17/1000 live births. 79.5% of cases presented within the first 24 hours of life, while 15% presented between 72 h-7 days. GBS accounted for 41.7% of cases, while EC accounted for 35.4%. Resistance was noted in 33.9% of cases overall. 55.6% of EC were resistant, with ampicillin resistance being the most common. The species of infecting organism was significantly associated with gestational age, very low birth weight, age at presentation, the mother having received GBS prophylaxis, and rupture of membranes lasting more than 18 h. GBS was most common in term and EC in preterm neonates. The overall EONS case fatality rate was 11%, with most of these being deaths from EC. CONCLUSION: Our study suggests a lower rate of EONS than historically suggested, with differing dominant organisms based on gestational ages of the neonates. Later ages at presentation and high rates of resistance especially among EC cases further complicate the picture. We recommend a review of the Canadian prevention and treatment guidelines based on our findings.

Maternal pneumococcal endometritis may cause early-onset neonatal sepsis

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis. A case of early-onset neonatal sepsis due to penicillin susceptible pneumococci and maternal endometritis is herein described. A male infant was born at 33 weeks of gestation. The baby developed S. pneumoniae bacteraemia and recovered completely following treatment with antibiotics. Four days after partum, the mother was readmitted with fever. S. pneumoniae was recovered from an endometrial sample. Isolates from mother and child were both serogroup 1 and confirmed to be identical on the basis of BOX-polymerase chain reaction typing and pulse-field gel electrophoresis. Perinatal transmission of S. pneumoniae had probably occurred due to ascending infection from the maternal genital tract.

The Risk Factors of Early Onset Neonatal Sepsis

Introduction: Neonatal sepsis is one of the major causes of morbidity and mortality in newborn. Early onset neonatal sepsis (EONS) is a severe disease and has high mortality rate. The clinical signs of EONS are nonspecific and the confirmation of diagnosis may consuming time. Therefore, the diagnostic approach is necessary by considering the risk factors. Objective: The aims of this study are to identify the risk factors of newborn infants whose mother has risk factors of sepsis affecting the occurrence of EONS. Methods: This is a cohort retrospective study, conducted from January 2013 to June 2014 in Neonatology Installation of Dr. Wahidin Sudirohusodo hospital, Makassar. The sample population included newborn infants whose mother has risk factors of sepsis. The information of the risk factors from infant and diagnoses of EONS was obtained from their medical record. Multivariate analysis and logistic regression formula were performed to predict the occurrence of EONS. There were 221 samples: 62 cases of EONS and 159 of control. Results: The results of multivariate analysis revealed 3 risk factors from infant which were associated to EONS: APGAR score <7 (p= 0.000, AOR 14.05 with 95% CI 5.48-35.98), gestational age <37 week (p= 0.000, AOR 13.45 with 95% CI 3.91-46.26), birth weight <1500 gram (p= 0.04, AOR 4.9 with 95% CI 1.08-22.25). Conclusion: Based on this study, it concluded that the risk factors of EOS were: APGAR score, gestational age and birth weight.

Early-onset sepsis in a neonatal intensive care unit in Beni Suef, Egypt: bacterial isolates and antibiotic resistance pattern

PurposeTo identify the frequency of bacterial isolates in early-onset neonatal sepsis (EONS) and their antimicrobial resistance pattern.MethodsA retrospective study of EONS was conducted at the Beni Suef University Hospital from September 2008 to September 2012. A case of EONS was defined as an infant who had clinical signs of infection or who was born to a mother with risk factors for infection, and in whom blood culture obtained within 72 hours of life grew a bacterial pathogen.ResultsOf 673 neonates screened, there were 138 positive blood cultures (20.5%) (confirmed EONS). Of the recovered isolates, 86.2% were gram-negative pathogens. Klebsiella pneumoniae (42.8%), Enterobacter cloacae (22.5%), and Escherichia coli (13.8%) were the commonest isolated organisms. The most common gram-positive microorganism was Staphylococcus aureus accounting for only 12 isolates (8.7%). All Klebsiella isolates and 93% of Enterobacter isolates were resistant to ampicillin. Gram-negative pathogens had the maximum overall sensitivity to imipenem, cefepime, and ciprofloxacin; whereas, gram-positive isolates were most susceptible to vancomycin, imipenem, and piperacillin.ConclusionK. pneumoniae was the predominant causative bacteria of EONS followed by E. cloacae and E. coli. There was a high resistance to ampicillin. Imipenem had the maximum overall activity against the causative bacteria. Continuous surveillance is needed to monitor the changing epidemiology of pathogens and antibiotic sensitivity.

Granulicatella adiacensand Early-Onset Sepsis in Neonate

<i>Granulicatella adiacens</i>and Early-Onset Sepsis in Neonate

Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: an audit from a center in India

BackgroundEpidemiology and surveillance of neonatal sepsis helps in implementation of rational empirical antibiotic strategy.ObjectiveTo study the frequency of bacterial isolates of early onset neonatal sepsis (EONS) and their sensitivity pattern.MethodsIn this retrospective study, a case of EONS was defined as an infant who had clinical signs or born to mothers with potential risk factors for infection, in whom blood culture obtained within 72 hours of life, grew a bacterial pathogen. Blood culture sample included a single sample from peripheral vein or artery. Relevant data was obtained from the unit register or neonatal case records.ResultsOf 2182 neonates screened, there were 389 (17.8%) positive blood cultures. After excluding coagulase-negative Staphylococci (160), we identified 229 EONS cases. Preterm neonates were 40.6% and small for gestational age, 18.3%. Mean birth weight and male to female ratio were 2344.5 (696.9) g and 1.16:1 respectively. Gram negative species represented 90.8% of culture isolates. Pseudomonas (33.2%) and Klebsiella (31.4%) were common among them. Other pathogens included Acinetobacter (14.4%), Staphylococcus aureus (9.2%), E.coli (4.4%), Enterobacter (2.2%), Citrobacter (3.1%) and Enterococci (2.2%). In Gram negative group, best susceptibility was to Amikacin (74.5%), followed by other aminoglycosides, ciprofloxacin and cefotaxime. The susceptibility was remarkably low to ampicillin (8.4%). Gram positive group had susceptibility of 42.9% to erythromycin, 47.6% to ciprofloxacin and above 50% to aminoglycosides. Of all isolates, 83.8% were susceptible to either cefotaxime or amikacinConclusionGram-negative species especially Pseudomonas and Klebsiella were the predominant causative organisms. Initial empirical choice of cefotaxime in combination with amikacin appeared to be rational choice for a given cohort.

Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics

In 2001 France issued a new set of guidelines for the use of antenatal antibiotics (AA). These guidelines recommended intrapartum antimicrobial prophylaxis (IAP) to prevent group B streptococcal (GBS) disease and AA to prolong pregnancy in the event of preterm premature rupture of membranes (AA for PPROM). This study aims to determine the effects of AA, recommended by national guidelines, on the incidence and distribution of pathogens in early-onset neonatal sepsis (EONS). We performed a population-based, prospective, observational study of level II and III perinatal centres throughout the region of Alsace, a northeastern area of France, between March 2004 and February 2005. The study population included all neonates with confirmed or probable EONS, who were treated with antibiotics for at least 5 days. We analysed exposure to AA, as well as clinical and microbiological data obtained from medical records. A total of 20 131 neonates were born during the study period, and 217 were included in the study. Of these, 24 subjects had confirmed sepsis, 140 had probable sepsis and 53 had possible EONS. The overall incidence of confirmed EONS was 1.19 per 1000 births. The infecting bacteria was GBS in 15 of 24 (62.5%) confirmed EONS cases (incidence: 0.75 per 1000 births) and in 81 of 140 (58%) probable sepsis cases. Escherichia coli was identified in 6 of 24 (25%) cases of confirmed EONS (incidence: 0.3 per 1000 births) and in 30 of 140 (21%) cases of clinical sepsis. Among E. coli infections (n= 36), amoxicillin resistance (n= 18) was statistically linked with AA use (P = 0.045). This link was significant in cases of PPROM (P = 0.015), but not when IAP was administered to prevent GBS disease (P = 0.264). IAP was not performed in 18 of 60 (30%) cases and 32 of 93 (34%) cases, despite positive screening or the presence of risk factors for EONS, respectively. Group B streptococcus remains the predominant pathogen in the era of AA. Aminopenicillin-resistant E. coli infections seem to be linked to prolonged AA in cases of PPROM and appear to preferentially affect preterm infants. Therefore, postnatal treatment strategies should consider this possible effect. Our data indicate that the current policy of GBS maternal prophylaxis is not associated with an excessive risk of pathogen resistance. Considering the high incidence of GBS EONS in our region, possible progress could result from better observance of guidelines. These results strengthen the need for continuation of surveillance.