Incidence Of Early-onset Infection Research Articles

Adherence to three different strategies to prevent early onset GBS infection in newborns

ProblemDespite the introduction of preventive guidelines, no decrease in the incidence of early onset infection was observed. BackgroundEarly onset group B streptococcal (EOGBS) infection is an important cause of neonatal morbidity and mortality. AimOur study was conducted to determine adherence to three guideline-based group B streptococcus (GBS) preventive strategies. MethodsA prospective experimental study clustered by obstetric collaboration region was performed between March 2013 and August 2014 among midwives, obstetricians and paediatricians in the Netherlands. At baseline, the three regions operated according to the Dutch preventive strategy (founded on the risk-based strategy) in order to prevent EOGBS infection, whereas in the study period they followed either the risk-based, the combination or the Dutch strategy. Adherence was measured prospectively per pregnant woman, using predefined core elements of each preventive strategy: identification of risk factors, maternal GBS screening, application of intrapartum antibiotic prophylaxis and observation of the child. Data about adherence to the core elements were collected from medical records, maternal questionnaires and laboratory test results. FindingsIn the three regions, a total of 121 care providers and 1562 women participated.We found an overall adherence of 90% to the risk-based strategy, 57% to the combination strategy and 89% to the Dutch strategy. Adherence to a strategy in case women had EOGBS risk factors was below 20% in all strategies. DiscussionThe majority of women with EOGBS risk factors did not receive the care prescribed by any of three preventive strategies and were not treated optimally. ConclusionThe risk-based and the Dutch strategy are the recommended strategies for implementation.

Bacteriology and risk factors associated with periprosthetic joint infection after primary total knee arthroplasty: retrospective study of 2543 cases.

Periprosthetic joint infection after total knee arthroplasty is a serious complication. This study aimed to identify risk factors and bacteriological features associated with periprosthetic joint infection after primary total knee arthroplasty performed at a teaching hospital. We reviewed 2543 elective primary total knee arthroplasties performed at our institution from 1993 to 2013. Data were collected from the Hong Kong Hospital Authority's Clinical Data Analysis and Reporting System, the Infection Control Team, and the joint replacement division registry. The association between potential risk factors and periprosthetic joint infection was examined by univariable analysis and multivariable logistic regression. Univariable analyses were also performed to examine the association between potential risk factors and bacteriology and between potential risk factors, including bacteriology, and early-onset infection. The incidence of periprosthetic joint infection in our series was 1.34% (n=34). The incidence of early-onset infection was 0.39% (n=24). Of the periprosthetic joint infections, 29.4% were early-onset infections. In both univariable and multivariable analyses, only rheumatoid arthritis was a significant predictor of periprosthetic joint infection. Methicillin-sensitive Staphylococcus aureus was the most common causative organism. We did not identify any significant association between potential risk factors and bacteriology. Periprosthetic joint infection caused by skin flora was positively associated with early-onset infection but the association was not statistically significant. The incidence of periprosthetic joint infection after elective primary total knee arthroplasty performed at our institution from 1993 to 2013 was 1.34%. Rheumatoid arthritis was a significant risk factor for periprosthetic joint infection.

Chorioamnionitis and early-onset neonatal infection.

Chorioamnionitis is associated with early-onset neonatal infection, but only a small fraction of women with chorioamnionitis has an infected infant. US guidelines recommend empiric antibiotics for well-appearing infants of mothers with chorioamnionitis. A 4-year US study of early-onset neonatal infection (defined as positive blood or CSF culture ≤72 h) collected data about clinical or histopathological maternal chorioamnionitis. An analysis aimed to determine how many chorioamnionitis-exposed infected infants were asymptomatic at birth.1 The incidence of early-onset infection was 1.02 per 1000 live births (389 episodes in 396 586 births). The mothers of 60% of infected infants had a diagnosis of chorioamnionitis; 29 (13%) of 229 had no reported symptoms at 6 h, and 21 (9%) remained symptom free at 72 h. Asymptomatic infants were no more likely than symptomatic infants to have received intrapartum antibiotics. Most infected infants (65%) were born preterm, 91% of them at 22–33 weeks' gestation, itself a risk factor for infection likely to warrant starting antibiotics. The authors estimated that, if current guidelines were followed and depending on chorioamnionitis prevalence, 60 to 1400 newborns would receive antibiotics for each infected asymptomatic newborn. Some chorioamnionitis-exposed newborns with culture-confirmed early-onset neonatal infection are asymptomatic, but empiric treatment on the basis of chorioamnionitis also results in treating large numbers of asymptomatic infants.

Recurrent respiratory infections in the follow-up of the extremely low birth weight infant

Most of the extremely low birth weight (ELBW) infants, those with a birth weight <1,000 g, are also the youngest of premature newborns, usually with a <27 weeks’ gestational age (wGA). ELBW survival has improved with advancement of neonatal technologies, but survivors may face early and life-long morbidities that includeinfectious respiratory disorders[1]. This increased predisposition is related to a variety of immunological, structural and iatrogenic factors. At the time of term birth, the innate immune response has not fully matured and the adaptive immune system must still develop specificity and memory, completed only in the early childhood [2]. The immaturity of the innate immune systemis more pronounced in preterm infants. The classical, alternative and lectin complement pathways are all reduced in their pathogen-killing abilities and the production and release of soluble antimicrobial proteins and peptidesby leukocytes are deficient. Preterm infants have reduced pool of neutrophils and monocytes and their precursors, compared to term-neonates, and have deficient T cell function with greater proportion of naive T cells and a low subpopulation of memory T cells. A reduction in lymphocyte subpopulations is still detectable at 8 years of age. There is also a limited production of immunoglobulin (Ig) by the fetus and antigen-specific IgGs are transferred across the placenta from the maternal circulation in large amounts after 32wGA. The lung structures are also structurally and functionally immature in the ELBW. An early complication of extreme prematurity is respiratory distress syndrome caused by surfactant deficiency, with collapse of the alveolar structures, atelectasis edema and decreased lung capacity. Supplemental oxygen and ventilatorysupport may leadto complication, such as air leak syndrome and chronic lung disease of prematurity and increase the risk of persistent damage to the fragile, immature pulmonary structures [3]. Infections are a major contribution to the morbidity and mortality of ELBW infants at any time of the clinical course [4]. The incidence of early-onset infections, due to bacteria from the maternal genital tract but also to nosocomial environmental bacteria and fungi and to airborne viruses, increases in the U.S.A. from <1/1000 live births to 8/1000 in ELBW births. ELBW infants are also at high risk of vaccine-preventable diseases, such as pertussis and Haemophilus influenzae and Corynebacterium diphtheriae infections: according to the international recommendations, they should receive full doses of the conjugate vaccines at the appropriate chronological age [5].

Infección tardía por estreptococo grupo B en gemelos nacidos mediante cesárea

Group B Streptococcus (GBS) is a commensal pathogen of the gut microflora with a well-established role in the aetiology of early and late onset GBS infections in the newborn. The incidence of early onset infections by vertical transmission has been drastically reduced in recent decades with the use of intravenous intrapartum prophylaxis. Progress in risk factor detection and prophylaxis of late-onset infection has however remained static.The ongoing modifications and improvements of the guidelines regarding prophylaxis, risk factors and prevention of the early-onset GBS disease have not addressed late-onset GBS infection in detail.The following cases illustrate the presence of grey areas in current guidelines and in the knowledge of the pathogenesis of late-onset disease.

Pattern and etiology of culture-proven early-onset neonatal sepsis: a five-year prospective study

To investigate the incidence of early-onset neonatal sepsis and identify the main pathogens over a 5-year period in Kuwait. Blood samples were collected from all infants with any clinical or laboratory feature suggestive of sepsis, at the main maternity hospital in Kuwait. Cases of early-onset neonatal infection were defined as culture of a single potentially pathogenic organism from blood or cerebrospinal fluid from infants younger than 7 days of age, in association with clinical or laboratory findings consistent with infection. The overall incidence of early-onset neonatal infection was 2.7 (95% confidence interval (CI) 2.3-3.2) episodes per 1000 live-births. The case-fatality was 13.1% (95% CI 8.6-18.9%). Group B Streptococcus (GBS) accounted for 17.6% of infections among infants younger than 7 days (incidence 0.48 per 1000 live-births), but 38.1% of infections in the first 2 days of life. Neither the incidence of early-onset infection by GBS nor by Escherichia coli changed significantly over the study period. Although the incidence of GBS infections was relatively low, GBS accounted for most early-onset infections. Intrapartum antibiotic prophylaxis against GBS should be strengthened. There was no evidence to suggest that early-onset infection due to non-GBS organisms such E. coli has increased in the last 5 years.

Group B streptococcal disease in Portuguese infants younger than 90 days

Background:Group B streptococcus (GBS) is the most common isolate in mother-related infection in newborns.Aims:To evaluate the epidemiology of GBS infection in the first 90 days after birth; to determine if...

Intrapartum antibiotics and early onset neonatal sepsis caused by group B Streptococcus and by other organisms in Australia. Australasian Study Group for Neonatal Infections.

Early onset group B streptococcal (EOGBS) infection, the major neonatal infection in industrialized countries, can be prevented by intrapartum antibiotics, but population studies are lacking. This study aimed to determine the incidence of early onset infections caused by group B Streptococcus (GBS) and other organisms in Australia and to assess intrapartum antibiotic use. Longitudinal, prospective surveillance of neonatal infections in Australian neonatal units from 1991 to 1997. Early onset infection defined as clinical sepsis in first 48 h after birth, with positive cultures of blood or cerebrospinal fluid or positive urine GBS antigen detection. The incidence of EOGBS sepsis fell from 2.0 per 1000 live births (95% confidence interval, 1.4, 2.5) in 1991 to 1993, to 1.3 (1.2, 1.4) in 1993 to 1995, to 0.5 (0.4, 0.7) in 1995 to 1997 (P < 0.0001). The incidence in Aboriginal babies was 5.2 (1.8, 8.6) in 1991 to 1993, 5.1 (3.0, 7.2) in 1993 to 1995 and 1.8 (1.1, 2.5) in 1995 to 1997 (P < 0.05). The incidence of early onset infections caused by organisms other than GBS also fell, from 1.2 per 1000 live births (0.8, 1.7) in 1991 to 1993, to 0.8 (0.7, 0.9) in 1993 to 1995 and 0.5 (0.3, 0.7) in 1995 to 1997 (P < 0.0001). In 1991, 3 of 9 study hospitals had a formal policy on intrapartum antibiotic use, whereas in 1997 all 11 hospitals had a formal policy (P=0.002). A steady fall in EOGBS infections in Australia from 1991 to 1997 has been associated with increasing use of intrapartum antibiotics. Increased antibiotic use is probably causal in the fall in GBS, because the incidence of early onset infections caused by other organisms has also fallen.