Long-Term Trends in the Epidemiology of Neonatal Sepsis and Antibiotic Susceptibility of Causative Agents

Abstract

Background: In an era with increased maternal antibiotic use, patterns in early- and late-onset sepsis and antibiotic susceptibility may have changed. Objectives: To identify longitudinal trends in causative microorganisms for neonatal sepsis and analyze antibiotic susceptibility of all blood isolates of infants with sepsis. Methods: Early- and late-onset sepsis cases from 29 years (1978–2006) were studied retrospectively, in five clusters of 5 years (period I–V) and one cluster of 4 years (period VI), including antibiotic susceptibility profiles of blood isolates during the years 1999–2006. Results: The incidence of early-onset sepsis decreased (p < 0.01) from 4% during period I (1978–1982) to 1.2% during period VI (2003–2006). 78% of the infants with group B streptococcal (GBS) sepsis were premature during period I, compared to 47% during period VI (p < 0.05). The incidence of early-onset Gram-negative infections remained low during all periods. The incidence of late-onset sepsis, predominantly caused by coagulase-negative staphylococci (CONS) and Staphylococcus aureus, increased since period III from 7.1 to 13.9% in period VI (p < 0.01). Infections due to fungi or yeasts were rare (incidence <0.3%). The majority of CONS blood isolates were oxacillin-resistant, but vancomycin-susceptible. 95% of CONS blood isolates were susceptible for first-generation cephalosporins. Amoxicillin/clavulanic acid-resistant Escherichia coli were infrequent causes of infection. Conclusions: The incidence of early-onset sepsis mainly caused by GBS decreased. In contrast, the incidence of late-onset sepsis, predominantly caused by CONS, increased significantly. The incidence of fungal and yeast infections remained low. The majority of CONS blood isolates were susceptible for first-generation cephalosporins.

Brief communication (Original). Trends in neonatal sepsis in a neonatal intensive care unit in Thailand before and after construction of a new facility

“…The rates of sepsis in this study are comparable to those in units in Taiwan that reported rates ranging from 3% to 4% [18,19], but lower compared with data from other countries such as the Philippines, The Netherlands, and Nigeria, where sepsis rates have been reported to range from 15.1% to 19.6% [20][21][22]. Furthermore, at 2.68 cases per 1,000 live births, the rate of sepsis for inborn infants was lower than that reported in other countries including Korea (5.9 cases per 1,000 live births) [23], the USA (6.1 cases per 1,000 live births) [4], and India (14.8 cases per 1,000 live births) [24].…”

“…In the USA, the overall cumulative incidence of EOS is from 0.8 to 1.0 cases per 1,000 live births [9] and the rate of LOS is 36% in preterm infants (22)(23)(24)(25)(26)(27)(28) weeks gestational age/401-1500 g birth weight) [10]. Similarly, two studies of groups of neonatal intensive care unit (NICUs) in developing countries including Malaysia, Thailand, China, and India, found the rate of EOS to be from 0.62 to 0.72 cases per 1,000 live births [11,12].…”

Neonatal septicaemia: prevalence and antimicrobial susceptibility patterns of common pathogens at Princess Marina Hospital, Botswana

“…2 Neonatal septicaemia can be categorised as earlyonset neonatal sepsis, representing maternally derived infections; and late-onset neonatal sepsis, representing hospital-acquired infection. 3,4 Knowledge of the local epidemiology of neonatal sepsis assists clinicians and infection control programmes to prioritise interventions for prevention of neonatal sepsis-related morbidity and mortality.…”

Reposicionando la cloxacilina como antibioticoterapia empírica inicial de la sepsis tardía neonatal

“…Esto se ha facilitado por el uso prolongado de antimicrobianos sin la suspensión precoz luego de no comprobarse la presencia de infección, ya sea, por la ausencia de síntomas clínicos y/o hemocultivos negativos, provocando el aumento de las tasas de infecciones por microorganismos resistentes y gramnegativos. Se ha demostrado adicionalmente, que vancomicina es uno de los principales antimicrobianos que favorecen el aumento de las tasas de infecciones por candidas en una UCIN, lo que constituye un grave y emergente problema en las UCIN en el mundo con aumento significativo de la morbi-mortalidad 28 . La aparición de microorganismos resistentes a vancomicina, como Enterococcus y S. aureus constituye un problema agregado al ya expuesto, dado que pueden causar infecciones graves, potencialmente mortales, con opciones terapéuticas limitadas y de alto costo, ocasionando importantes impactos en la salud pública.…”