Early-Onset Sepsis in Neonates - A Population-Based Study in South-West Norway From 1996 to 2018

Abstract

Background: The epidemiology of early-onset sepsis (EOS) may change over time. Longitudinal surveillance of causative pathogens, antibiotic susceptibility patterns and antibiotic therapy is important for optimal therapy strategies.Objectives: To describe the incidence of culture-confirmed EOS, causative pathogens, antibiotic susceptibility patterns and antibiotic therapy over a 23-year period.Methods: Retrospective population-based study from a single-center neonatal intensive care unit at Stavanger University Hospital, Norway, covering a population in South-West Norway, during the 23-year period 1996–2018.Results: Of 104,377 live born infants, 101 infants (0.97/1,000) had culture-confirmed EOS; 89 with Gram positive and 12 with Gram-negative bacteria. The EOS-attributable mortality was 6/101 (5.8%). For the three most prevalent pathogens the incidences were; Group B streptococcus (GBS) 0.57/1,000, Escherichia coli 0.11/1,000 and viridans group streptococci (VGS) 0.10/1,000. GBS was the most common pathogen (59/93; 63%) in infants with gestational age (GA) ≥ 28 weeks. In contrast, among extremely preterm infants (GA <28 weeks) the incidence of E. coli infection was higher than for GBS infection. The second most common bacterial pathogens causing EOS among term infants were VGS. There was no change in the incidence of EOS for the entire study period, but from 2000 to 2018 there was a mean decline in EOS by 6% per year (95% CI 1%−10%) (p = 0.019). The incidences of GBS and E. coli did not change during the study period. The initial empirical antibiotic regimen for EOS was in all cases a combination of benzylpenicillin or ampicillin and an aminoglycoside, but in 21/101 (21%) of cases a broad-spectrum antibiotic was either added or substituted this regimen. In 2/101 (2%) EOS cases, the pathogens were nonsusceptible to the empirical antibiotic regimen. All E. coli isolates were susceptible to aminoglycosides.Conclusion: GBS was the most common causative pathogens in EOS, but E. coli dominated in infants with GA <28 weeks. There was no change in the incidence of EOS during the entire study period. The current empiric regimen with benzylpenicillin and gentamicin provides a very high coverage for EOS in our setting.

Early-Onset Neonatal Sepsis in Turkey: A Single-Center 7-Year Experience in Etiology and Antibiotic Susceptibility

“…After implementing intrapartum antibiotic prophylaxis, the incidence and mortality of EOS have decreased significantly in the past decades, especially in developed countries [ 1 , 2 ]. The incidence of EOS was 0.32–0.97 per 1000 live births in Europe, comparable to reports from the USA (1.08/1000) and Australia (0.67/1000) [ 1 , 2 , 3 , 4 , 5 ]. However, its incidence remains higher in developing countries, where data is scarce [ 6 , 7 ].…”

“…The etiology of EOS has changed dramatically after implementing guidelines for routine group B Streptococcus (GBS) screening. Although it has been shown that E. coli has become the most frequently detected pathogen in EOS of extremely preterm infants, the leading microorganism for EOS is still GBS in developed countries [ 4 , 8 ]. Evidence indicates that the pathogen distribution of EOS differs among developing and middle-income countries in the Middle East region and Asia, where GBS is less frequently reported, while Gram-negative pathogens, such as Klebsiella pneumoniae and E. coli , are the major pathogens and are less likely to be susceptible to currently recommended empirical antibiotic therapy [ 6 , 7 , 9 ].…”

Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities

“… 32–35 Comparably, a study from Norway reported EOS incidence of 0.97/1000 live births between 1996–2018. 36 Whereas, a study in Greece reported a weighted EOS incidence rate of 1.8/1000 live births, 37 indicating some variability in the HIC data. A higher EOS was similarly reported in a large study among preterm infants conducted in China (upper-middle income) between 2015–2018 (n=27,532 enrolled infants) with an incidence of 9.7/1000 live births.…”

Emerging Fatal Ib/CC12 Hypervirulent Multiresistant Streptococcus agalactiae in Young Infants With Bloodstream Infection in China

“…Streptococcus agalactiae (also termed as group B Streptococcus , GBS) is a leading cause of invasive disease in neonatal and young infant patients, although intrapartum antimicrobial prophylaxis (IAP) has significantly reduced the incidence of early onset GBS infection ( Tan et al, 2021 ; Vatne et al, 2021 ; Wong et al, 2021 ). A recent survey revealed that families with a baby with GBS infection suffered significant financial and psychological difficulties ( Raybould et al, 2021 ).…”