Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The impact of group B streptococcus prophylaxis on late-onset neonatal infections

Journal of Perinatology volume 33, pages 206–211 (2013)Cite this article

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. 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.

    PubMed  Google Scholar 

  2. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. 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.

    PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The study was funded by The Thomas Wilson Sanitarium for the Children of Baltimore City.

Author information

Authors and Affiliations

  1. Division of Neonatology, Crozer Chester Medical Center, Upland, PA, USA

    K L Ecker

  2. Assistant Professor of Pediatrics, and Population, Family and Reproductive Health, The Johns Hopkins University School of Medicine, and Johns Hopkins Bloomberg, School of Public Health, Baltimore, MD, USA

    P K Donohue

  3. Professor of Pediatrics,

    K S Kim

  4. Division of Pediatric Infectious Disease, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    K S Kim

  5. Research Nurse,

    J A Shepard

  6. Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    J A Shepard

  7. Associate Professor of Pediatrics,,

    S W Aucott

  8. Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    S W Aucott

Authors
  1. K L Ecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P K Donohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K S Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J A Shepard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S W Aucott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K L Ecker.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.76

Keywords

Search

Advanced search

Quick links