PEDIATRICS Vol. 110 No. 4 October 2002, pp. 690-695
Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta
* Active Bacterial Core surveillance (ABCs) of the Emerging Infections Program Network, Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Emerging Infections Program, San Francisco, California, and the School of Public Health, University of California, Berkeley, California
|| Emerging Infections Program, Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, Georgia
--> Objective. Although increased use of intrapartum antibiotics caused significant declines in early-onset group B Streptococcus (GBS) infection, the effect on infections caused by other pathogens is not clear. The objective of this study was to determine trends in the incidence of early-onset sepsis caused by organisms other than group B streptococcus in the era of antimicrobial prophylaxis.
Methods. We conducted surveillance for early-onset sepsis as part of the Active Bacterial Core surveillance. A case was defined as isolation of bacteria from blood or cerebrospinal fluid from an infant who was 0 to 6 days of age and born in the surveillance area during 1998 through 2000 (248 184 births).
Results. We identified 408 cases of early-onset infection. GBS caused 166 (40.7%) cases (52 in 1998, 51 in 1999, and 63 in 2000 for incidences 0.62, 0.62, and 0.76 cases per 1000 live births, respectively). Other bacterial pathogens were identified in 242 cases (82 in 1998, 79 in 1999, and 81 in 2000 for incidences 0.99, 0.95, and 0.98 per 1000 live births, respectively) of early-onset sepsis. Escherichia coli caused 70 cases (0.25, 0.28, and 0.31 cases per 1000 live births, respectively, in 1998–2000). The proportion of E coli infections that were resistant to ampicillin increased significantly among preterm infants from 29% (2 of 7) in 1998 to 84% (16 of 18) in 2000 but not in full-term infants: 50% (4 of 8) in 1998 and 25% (1 of 4) in 2000.
Conclusions. Whereas rates of early-onset sepsis caused by GBS and other pathogens were low and did not change significantly during the study period, antibiotic-resistant E coli infections among preterm infants increased. Overall, these trends are reassuring, but careful evaluation of the increase in resistant infections in very young infants is critical in the future.
Key Words: neonatal sepsis • group B Streptococcus • guidelines • surveillance • Escherichia coli • antimicrobial resistance
Abbreviations: GBS, group B Streptococcus • CSF, cerebrospinal fluid
Received for publication Jan 17, 2002; Accepted Apr 26, 2002.
This article has been cited by other articles:
 |
|
 |
|
  K. M. Puopolo Epidemiology of Neonatal Early-onset Sepsis NeoReviews, December 1, 2008; 9(12): e571 - e579. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Bizzarro, L.-M. Dembry, R. S. Baltimore, and P. G. Gallagher Changing Patterns in Neonatal Escherichia coli Sepsis and Ampicillin Resistance in the Era of Intrapartum Antibiotic Prophylaxis Pediatrics, April 1, 2008; 121(4): 689 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Millar, A. Philpott, M. Wilks, A. Whiley, S. Warwick, E. Hennessy, P. Coen, S. Kempley, F. Stacey, and K. Costeloe Colonization and Persistence of Antibiotic-Resistant Enterobacteriaceae Strains in Infants Nursed in Two Neonatal Intensive Care Units in East London, United Kingdom J. Clin. Microbiol., February 1, 2008; 46(2): 560 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Konrad and A. Katz Epidemiology of early-onset neonatal group B streptococcal infection: Implications for screening Can Fam Physician, June 1, 2007; 53(6): 1054 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Konrad, S. Hauch, and C. Pylypjuk Prevention of neonatal group B streptococcal infection: Approaches of physicians in Winnipeg, Man Can Fam Physician, February 1, 2007; 53(2): 289 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Santos-Sierra, D. T. Golenbock, and P. Henneke Toll-like receptor-dependent discrimination of streptococci Innate Immunity, October 1, 2006; 12(5): 307 - 312. [Abstract] [PDF]
|
|
|
|
|
|
S. J. Schrag, J. L. Hadler, K. E. Arnold, P. Martell-Cleary, A. Reingold, and A. Schuchat Risk Factors for Invasive, Early-Onset Escherichia coli Infections in the Era of Widespread Intrapartum Antibiotic Use Pediatrics, August 1, 2006; 118(2): 570 - 576. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Henneke and R. Berner Interaction of neonatal phagocytes with group B streptococcus: recognition and response. Infect. Immun., June 1, 2006; 74(6): 3085 - 3095. [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Poehling, T. R. Talbot, M. R. Griffin, A. S. Craig, C. G. Whitney, E. Zell, C. A. Lexau, A. R. Thomas, L. H. Harrison, A. L. Reingold, et al. Invasive Pneumococcal Disease Among Infants Before and After Introduction of Pneumococcal Conjugate Vaccine JAMA, April 12, 2006; 295(14): 1668 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. Glasgow, P. C. Young, J. Wallin, C. Kwok, G. Stoddard, S. Firth, M. Samore, and C. L. Byington Association of Intrapartum Antibiotic Exposure and Late-Onset Serious Bacterial Infections in Infants Pediatrics, September 1, 2005; 116(3): 696 - 702. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M May, A J Daley, S Donath, D Isaacs, and on behalf of the Australasian Study Group for Neon Early onset neonatal meningitis in Australia and New Zealand, 1992-2002 Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2005; 90(4): F324 - f327. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Puopolo, L. C. Madoff, and E. C. Eichenwald Early-Onset Group B Streptococcal Disease in the Era of Maternal Screening Pediatrics, May 1, 2005; 115(5): 1240 - 1246. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Vergnano, M Sharland, P Kazembe, C Mwansambo, and P T Heath Neonatal sepsis: an international perspective Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2005; 90(3): F220 - f224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Jaureguy, M. Carton, P. Panel, P. Foucaud, M.-J. Butel, and F. Doucet-Populaire Effects of Intrapartum Penicillin Prophylaxis on Intestinal Bacterial Colonization in Infants J. Clin. Microbiol., November 1, 2004; 42(11): 5184 - 5188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Rentz, M. H. Samore, G. J. Stoddard, R. G. Faix, and C. L. Byington Risk Factors Associated With Ampicillin-Resistant Infection in Newborns in the Era of Group B Streptococcal Prophylaxis Arch Pediatr Adolesc Med, June 1, 2004; 158(6): 556 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Gilbert Prenatal screening for group B streptococcal infection: gaps in the evidence Int. J. Epidemiol., February 1, 2004; 33(1): 2 - 8. [Full Text] [PDF]
|
|
|
|
 |
|
 W. P. Kanto Jr and C. J. Baker New Recommendations For Prevention of Early-onset Group B Streptococcal Disease In Newborns Pediatr. Rev., July 1, 2003; 24(7): 219 - 221. [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Baker and W. P. Kanto Jr. Implementing new GBS guidelines requires coordinated care AAP News, February 1, 2003; 22(2): 79 - 86. [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Fay, C. J. Wenninger, M. Khandelwal, O. H. Harmanli, S. J. Schrag, A. Schuchat, and J. Mohle-Boetani Prevention of Early-Onset Group B Streptococcal Disease in Neonates N. Engl. J. Med., November 28, 2002; 347(22): 1798 - 1799. [Full Text] [PDF]
|
|
