Potential consequences of widespread antepartal use of ampicillin

Towers, Craig V.; Carr, Margaret H.; Padilla, Guadalupe; Asrat, Tamerou

doi:10.1016/s0002-9378(98)70182-6

Cited by 177 publications

(93 citation statements)

References 9 publications

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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: 81%

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: 81%

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

et al. 2005

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“…24 In addition, administration of antepartum ampicillin has been associated with ampicillin resistance in GNR isolates from infected infants. 3,5,25 In some hospitals, 70% of E. coli isolates are resistant to ampicillin which is commonly used empirically for neonatal sepsis. 25 Also, consistent with previous studies, E. coli was found to be the most commonly isolated GNR.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The widespread use of intrapartum antibiotics to prevent disease from group B streptococci (GBS) has been shown to select for more resistant Gram-negative rod (GNR) organisms. 3,4 The importance of GNRs as a pathogen in the neonatal period, therefore, may be increasing. 3,[5][6][7] Practitioners often rely on cerebrospinal fluid (CSF) parameters rather than CSF culture to define meningitis because of the use of intrapartum antibiotics and the practice of delaying lumbar puncture (LP) until after blood culture results are available.…”

Section: Introductionmentioning

confidence: 99%

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

et al. 2006

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Objective: Neonatal meningitis is an illness with potentially devastating consequences. Early identification of potential risk factors for Gram-negative rod (GNR) infections versus Gram-positive cocci (GPC) infection prior to obtaining final culture results is of value in order to appropriately guide expirical therapy. We sought to compare laboratory and clinical parameters of GNR and GPC meningitis in a cohort of term and premature infants.Study Design: We evaluated lumbar punctures from neonates cared for at 150 neonatal intensive care units managed by the Pediatrix Medical Group Inc. We compared cerebrospinal fluid (CSF) parameters (white blood cell count, red blood cell count, glucose, and protein), demographics, and outcomes between infants with GNR and GPC meningitis. CSF cultures positive with coagulase-negative staphylococci were excluded. Results:We identified 77 infants with GNR and 86 with GPC meningitis. There were no differences in gestational age, birth weight, infant sex, race, or rate of Caesarean section. GNR meningitis was more often diagnosed after the third postnatal day and was associated with higher white blood cell and red blood cell counts. GNR meningitis diagnosed in the first 3 days of life was associated with antepartum antibiotic exposure. No difference was noted in either CSF protein or glucose levels. After correcting for gestational age, there was no observed difference in mortality between infants infected with GNR or GPC.Conclusion: Compared to GPC meningitis, GNR meningitis was associated with several aspects of the clinical history and laboratory findings including older age of presentation, antepartum exposure to antibiotics, and elevated CSF white blood cell and red blood cell counts.

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“…Conversely, because colonization with GBS concerns fewer than 20 % of pregnant women, there is a risk of overtreatment when using the risk-factor strategy. The widespread use of antibiotics is associated with maternal anaphylaxis [13] and the selection of resistant strains of Escherichia coli, now increasingly reported in neonatal sepsis [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Molecular-based Screening for Perinatal Group B Streptococcal Infection: Implications for Prevention and Therapy

2013

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Group B streptococci (GBS) are a leading cause of infectious neonatal morbidity and mortality. Timely and accurate identification of colonized pregnant women is imperative to implement intrapartum antibioprophylaxis (IAP) to reduce the risk of early neonatal sepsis. Current guidelines recommend screening for GBS carriage with vaginal-rectal cultures. However, cultures require 24-72 h, thus precluding their use for intrapartum screening and these are only performed at 35-37 weeks gestation. New rapid molecular-based tests can detect GBS within hours. They have the potential to be used intrapartum and to allow for selective IAP in women carrying GBS. An advantage is that they can sometimes be performed by non-laboratory staff in the labor suite, thus avoiding delays in sample transfers to the microbiology laboratory. Another possible use of molecular-based assays is for the diagnosis of neonatal sepsis, where tests with a short turnaround time and high sensitivity and specificity are crucial. In this situation, the detection of microorganisms once antibiotic therapy has already been started is important, as treatment is started immediately once sepsis is suspected without waiting for microbiological confirmation. In this article, we discuss the state-of-the-art molecular-based tests available for GBS screening during pregnancy, as well as their implications for IAP for the diagnosis and prevention of neonatal sepsis.

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Potential consequences of widespread antepartal use of ampicillin

Cited by 177 publications

References 9 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

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

Molecular-based Screening for Perinatal Group B Streptococcal Infection: Implications for Prevention and Therapy

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