Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Laugel, Vincent; Kuhn, Pierre; Beladdale, J; Donato, Luigi; Escande, B; Astruc, Dominique; Messer, J

doi:10.1159/000071439

Cited by 21 publications

(29 citation statements)

References 29 publications

(58 reference statements)

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“…1,2 The reason for this remains controversial, and concerns have been raised that more frequent use of maternal antibiotic treatment during pregnancy might have reduced the incidence of Gram-positive septicemia while facilitating growth of Gram-negative bacterial flora. 12,13 The large proportion of Gram-negative septicemia despite the rather moderate use of maternal systemic antibiotic therapy in the present study does not convincingly support this theory.…”

Section: Discussioncontrasting

confidence: 76%

Septicemia in the First Week of Life in a Norwegian National Cohort of Extremely Premature Infants

et al. 2005

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ABSTRACT. Objectives. To investigate the incidence, causes, predictors, and outcomes of septicemia in the first week of life in a national cohort of extremely premature infants.Methods. A prospective study of survival of all infants with gestational age of <28 weeks or birth weight of <1000 g who were born in Norway in 1999 -2000 was performed. Data on the maternal prenatal history, delivery, and neonatal course, including detailed information on episodes of microbiologically verified septicemia, were collected on predefined forms. Septicemia was reported in 2 groups, ie, episodes diagnosed on the day of delivery (ie, very early-onset septicemia [VEOS]) and episodes diagnosed from day 2 to day 7 of life (ie, earlyonset septicemia [EOS]). Logistic regression models were used for the selection of variables for predictor analysis in each group.Results. Of 462 included infants, VEOS occurred for 15 (32.5 per 1000 population) and EOS for 15 (35.5 per 1000 population). The most prevalent bacteria were Escherichia coli in VEOS (n ‫؍‬ 9) and staphylococci (coagulase-negative staphylococci and Staphylococcus aureus) (n ‫؍‬ 15) in EOS. Case fatality rates were 40% and 13%, respectively. Independent predictive factors for VEOS were clinical chorioamnionitis (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 3.3-33.4) and high maternal age (OR: 1.2; 95% CI: 1.0-1.3), whereas not receiving systemic antibiotic therapy within 2 days of age (OR: 13.6; 95% CI: 3.7-50.2) and receiving nasal continuous positive airway pressure (n-CPAP) support at 24 hours of age (OR: 9.8; 95% CI: 2.5-38.4) independently predicted septicemia after the first day of life.Conclusions. Whereas vertically transmitted septicemia was dominated by Gram-negative bacteria, with predictors being exclusively of maternal origin, EOS was dominated by typically nosocomial flora, with n-CPAP treatment at 24 hours of age being a powerful predictor. Early n-CPAP treatment, as opposed to mechanical ventilation, as a powerful predictor of septicemia in the early neonatal period, even with adjustment for early systemic antibiotic treatment, is a new observation among extremely premature infants that warrants additional study. Pediatrics 2005;115:e262-e268. URL: www.pediatrics.org/cgi/ doi/10.1542/peds.2004-1834; early-onset septicemia, neonatal septicemia, population-based study, prospective study, very low birth weight, extreme prematurity, predictor analysis, logistic regression.

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Section: Discussioncontrasting

confidence: 76%

Septicemia in the First Week of Life in a Norwegian National Cohort of Extremely Premature Infants

et al. 2005

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“…Our cluster of persistent CoNS bacteremia ended shortly after clinical management when more aggressive antibiotic coverage began. No change in practice for coverage of early-onset sepsis was noted during this time period, so this was not felt to impact LOS trends [66] .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Development of Persistent Coagulase-Negative Staphylococci Bacteremia in the Neonate and Associated Short-Term and Discharge Morbidities

et al. 2010

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Background: Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in neonatal intensive care unit settings. Historically, authors have questioned the clinical significance of these bacteremia episodes. Recently, clusters of CoNS bacteremia associated with significant morbidity have been reported. The frequency and importance of these clusters of bacteremia and their associated morbidity remains unclear. Objective: We studied a prolonged cluster of 52 cases of persistent CoNS bacteremia in a level III neonatal intensive care unit to clarify risk factors, morbidity and outcomes associated with persistent CoNS bacteremia. Study Design: A retrospective case-control study of infants with CoNS bacteremia >48 h after initiation of appropriate antibiotics and gestational age-matched control infants was performed. We reviewed patient characteristics prior to and during bacteremia, and outcomes at discharge or death. Results: Persistently infected infants were significantly more likely to have greater duration of exposure to parenteral nutrition, hydrocortisone, antibiotics, and mechanical ventilation prior to infection. Persistently infected infants were significantly more likely than controls to experience feeding intolerance and to require inotropic support, increased respiratory support, and blood product transfusion during bacteremia. Infants with persistent CoNS bacteremia took longer to achieve full enteral feeds, had higher rates of chronic lung disease and increased length of stay compared to controls. No significant difference in mortality was noted. Conclusions: Persistent CoNS bacteremia is associated with clinically significant morbidity including feeding intolerance, respiratory failure, blood transfusion and chronic lung disease in this patient population. This impacts hospital course, increases length of stay and impacts medical needs after discharge. During this study, CoNS bacteremia was difficult to clinically eradicate despite in vitro antibiotic susceptibility.

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“…Some studies of EONI have been conducted in France [19,22,25], but no epidemiological studies of LONI have been performed to date.…”

Section: Introductionmentioning

confidence: 99%

Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics

Didier

Streicher²,

Chognot

et al. 2011

Eur J Pediatr

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Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Cited by 21 publications

References 29 publications

Septicemia in the First Week of Life in a Norwegian National Cohort of Extremely Premature Infants

Septicemia in the First Week of Life in a Norwegian National Cohort of Extremely Premature Infants

Risk Factors Associated with Development of Persistent Coagulase-Negative Staphylococci Bacteremia in the Neonate and Associated Short-Term and Discharge Morbidities

Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics

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