Document Detail


Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.
MedLine Citation:
PMID:  21518717     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen.
OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers.
METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was defined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence.
RESULTS: Among 396 586 LBs (2006-2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%).
CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.
Authors:
Barbara J Stoll; Nellie I Hansen; Pablo J Sánchez; Roger G Faix; Brenda B Poindexter; Krisa P Van Meurs; Matthew J Bizzarro; Ronald N Goldberg; Ivan D Frantz; Ellen C Hale; Seetha Shankaran; Kathleen Kennedy; Waldemar A Carlo; Kristi L Watterberg; Edward F Bell; Michele C Walsh; Kurt Schibler; Abbot R Laptook; Andi L Shane; Stephanie J Schrag; Abhik Das; Rosemary D Higgins;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-04-25
Journal Detail:
Title:  Pediatrics     Volume:  127     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-02     Completed Date:  2011-07-11     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  817-26     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, USA. barbara_stoll@oz.ped.emory.edu
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MeSH Terms
Descriptor/Qualifier:
Age of Onset
Anti-Bacterial Agents / therapeutic use
Bacteremia / drug therapy,  epidemiology,  prevention & control*
Escherichia coli / isolation & purification*
Escherichia coli Infections / drug therapy,  epidemiology,  prevention & control*
Female
Follow-Up Studies
Humans
Incidence
Infant, Newborn
Infant, Premature
Male
Neonatal Screening / organization & administration*
Primary Prevention / organization & administration
Registries
Retrospective Studies
Risk Assessment
Streptococcal Infections / drug therapy,  epidemiology,  prevention & control*
Streptococcus agalactiae / isolation & purification*
Survival Analysis
United States
Grant Support
ID/Acronym/Agency:
5P20RR11104/RR/NCRR NIH HHS; M01 RR54/RR/NCRR NIH HHS; M01 RR59/RR/NCRR NIH HHS; M01 RR6022/RR/NCRR NIH HHS; M01 RR633/RR/NCRR NIH HHS; M01 RR64/RR/NCRR NIH HHS; M01 RR70/RR/NCRR NIH HHS; M01 RR750/RR/NCRR NIH HHS; M01RR32/RR/NCRR NIH HHS; M01RR8084/RR/NCRR NIH HHS; MO1RR125/RR/NCRR NIH HHS; U01 HD36790/HD/NICHD NIH HHS; U10 HD053089/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS; U10 HD53089/HD/NICHD NIH HHS; U10 HD53109/HD/NICHD NIH HHS; U10 HD53119/HD/NICHD NIH HHS; U10 HD53124/HD/NICHD NIH HHS; U10HD27871/HD/NICHD NIH HHS; UL1 RR025008/RR/NCRR NIH HHS; UL1 RR24139/RR/NCRR NIH HHS; UL1 RR25764/RR/NCRR NIH HHS; UL1 TR000041/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections
Erratum In:
Pediatrics. 2011 Aug;128(2):390

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