Abstract
Objective:
To determine trends in late-onset neonatal infections and risk factors for ampicillin/penicillin-resistant microorganisms.
Study Design:
Data on 584 infants with positive blood, urine or cerebrospinal fluid cultures for bacteria or fungi at 8-30 days of age from 1990 to 2007 were examined and divided into three epochs, based on intrapartum antibiotic prophylactic (IAP) practices. Pathogens and antibiotic resistance were compared among epochs.
Result:
The number of candidal infections increased over time for the entire population (P=0.006). There was an increased incidence of Gram-negative (P=0.009) and candidal infections (P=0.014) among very low-birthweight infants. Only Escherichia coli infections showed increasing ampicillin resistance over epochs (P=0.006). In regression analysis, ampicillin/penicillin resistance increased with IAP use (odds ratio 2.05).
Conclusion:
Changing microorganisms and increasing antibiotic resistance in late-onset neonatal infections are likely multifactorial but are increased with IAP use, which may identify an at-risk population. Increasing Candida infections require further investigation.
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References
Waheed M, Laeeq A, Maqbool S . The etiology of neonatal sepsis and patterns of antibiotic resistance. J Coll Physicians Surg Pak 2003; 13 (8): 449–452.
Levine EM, Ghai V, Barton JJ, Strom CM . Intrapartum antibiotic prophylaxis increases the incidence of gram-negative neonatal sepsis. Infect Dis Obstet Gynecol 1999; 7 (4): 210–213.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347 (4): 240–247.
Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the national institute of child health and human development neonatal research network, 2002-2003. Pediatr Infect Dis J 2005; 24 (7): 635–639.
Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG . Changing patterns in neonatal escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 2008; 121 (4): 689–696.
Alarcon A, Pena P, Salas S, Sancha M, Omenaca F . Neonatal early onset escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis. Pediatr Infect Dis J 2004; 23 (4): 295–299.
Hyde TB, Hilger TM, Reingold A, Farley MM, O′Brien KL, Schuchat A et al. Trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta. Pediatrics 2002; 110 (4): 690–695.
Cordero L, Rau R, Taylor D, Ayers LW . Enteric gram-negative bacilli bloodstream infections: 17 years′ experience in a neonatal intensive care unit. Am J Infect Control 2004; 32 (4): 189–195.
Joseph TA, Pyati SP, Jacobs N . Neonatal early-onset escherichia coli disease. the effect of intrapartum ampicillin. Arch Pediatr Adolesc Med 1998; 152 (1): 35–40.
Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A . Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 2002; 51 (RR-11): 1–22.
Lin FY, Weisman LE, Troendle J, Adams K . Prematurity is the major risk factor for late-onset group B streptococcus disease. J Infect Dis 2003; 188 (2): 267–271.
Centers for Disease Control and Prevention (CDC). Early-onset and late-onset neonatal group B streptococcal disease--United States, 1996-2004. MMWR Morb Mortal Wkly Rep 2005; 54 (47): 1205–1208.
Jordan HT, Farley MM, Craig A, Mohle-Boetani J, Harrison LH, Petit S et al. Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease: a multistate, population-based analysis. Pediatr Infect Dis J 2008; 27 (12): 1057–1064.
Verani JR, McGee L, Schrag SJ . Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1–36.
Stoll BJ, Hansen NI, Sanchez PJ, Faix RG, Poindexter BB, Van Meurs KP et al. Early onset neonatal sepsis: the burden of group B streptococcal and E coli disease continues. Pediatrics 2011; 127 (5): 817–826.
Dahesh S, Hensler ME, Van Sorge NM, Gertz RE, Schrag S, Nizet V et al. Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to beta-lactam antibiotics. Antimicrob Agents Chemother 2008; 52 (8): 2915–2918.
Kimura K, Suzuki S, Wachino J, Kurokawa H, Yamane K, Shibata N et al. First molecular characterization of group B streptococci with reduced penicillin susceptibility. Antimicrob Agents Chemother 2008; 52 (8): 2890–2897.
Bromiker R, Arad I, Peleg O, Preminger A, Engelhard D . Neonatal bacteremia: patterns of antibiotic resistance. Infect Control Hosp Epidemiol 2001; 22 (12): 767–770.
Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T . Changing incidence of candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics 2006; 117 (5): 1680–1687.
Benjamin DK, Stoll BJ, Gantz MG, Walsh MC, Sanchez PJ, Das A et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics 2010; 126 (4): e865–e873.
Makhoul IR, Bental Y, Weisbrod M, Sujov P, Lusky A, Reichman B et al. Candidal versus bacterial late-onset sepsis in very low birthweight infants in israel: a national survey. J Hosp Infect 2007; 65 (3): 237–243.
Saiman L, Ludington E, Dawson JD, Patterson JE, Rangel-Frausto S, Wiblin RT et al. Risk factors for candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J 2001; 20 (12): 1119–1124.
Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR et al. Late-onset sepsis in very low birth weight neonates: a report from the national institute of child health and human development neonatal research network. J Pediatr 1996; 129 (1): 63–71.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics 2002; 110 (2 Part 1): 285–291.
Friedman S, Shah V, Ohlsson A, Matlow AG . Neonatal escherichia coli infections: concerns regarding resistance to current therapy. Acta Paediatr 2000; 89 (6): 686–689.
Acknowledgements
The study was funded by The Thomas Wilson Sanitarium for the Children of Baltimore City.
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Ecker, K., Donohue, P., Kim, K. et al. The impact of group B streptococcus prophylaxis on late-onset neonatal infections. J Perinatol 33, 206–211 (2013). https://doi.org/10.1038/jp.2012.76
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DOI: https://doi.org/10.1038/jp.2012.76