Document Detail


Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use.
MedLine Citation:
PMID:  16882809     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The goal was to evaluate risk factors for invasive Escherichia coli infections in the first week of life (early onset), focusing on the role of intrapartum antibiotic use. METHODS: We conducted a retrospective case-control study. Between 1997 and 2001, case infants, defined as infants < 7 days of age with E coli isolated from blood or cerebrospinal fluid, were identified in selected counties of California, Georgia, and Connecticut by the Active Bacterial Core Surveillance/Emerging Infections Program Network. Control infants (N = 1212) were identified from a labor and delivery record review of a stratified random sample of live births at the same hospitals in 1998 and 1999. RESULTS: Surveillance identified 132 E coli cases, including 68 ampicillin-resistant cases. The case fatality rate was 16% (21 of 132 cases). Two thirds of case infants were preterm, and 49% (64 of 132 infants) were born at < or = 33 weeks of gestation. Fifty-three percent of case mothers (70 of 132 mothers) received intrapartum antibiotic therapy; 70% of those received ampicillin or penicillin. Low gestational age (< or = 33 weeks), intrapartum fever, and membrane rupture of > or = 18 hours were associated with increased odds of early-onset E coli infection. Results were similar when case subjects were limited to those infected with ampicillin-resistant strains. Exposure to any intrapartum antibiotic treatment, beta-lactam antibiotic treatment, or > or = 4 hours of intrapartum antibiotic therapy was associated with increased odds of E coli infection and ampicillin-resistant infection in univariate analyses. Among preterm infants, intrapartum antibiotic exposure did not remain associated with either outcome in multivariable models. Among term infants, exposure to > or = 4 hours of intrapartum antibiotic therapy was associated with decreased odds of early-onset E coli infection. CONCLUSIONS: Exposure to intrapartum antibiotic therapy did not increase the odds of invasive, early-onset E coli infection. Intrapartum antibiotic therapy was effective in preventing E coli infection only among term infants.
Authors:
Stephanie J Schrag; James L Hadler; Kathryn E Arnold; Patricia Martell-Cleary; Arthur Reingold; Anne Schuchat
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  118     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-02     Completed Date:  2006-09-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  570-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia, USA. sschrag@cdc.gov
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MeSH Terms
Descriptor/Qualifier:
Adult
Ampicillin / therapeutic use
Ampicillin Resistance
Anti-Bacterial Agents / therapeutic use*
Antibiotic Prophylaxis*
California / epidemiology
Connecticut / epidemiology
Escherichia coli Infections / epidemiology*,  etiology,  mortality,  prevention & control
Female
Fetal Membranes, Premature Rupture / drug therapy,  epidemiology
Georgia / epidemiology
Humans
Incidence
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / epidemiology*,  etiology,  microbiology,  mortality,  prevention & control
Obstetric Labor Complications / drug therapy*,  epidemiology
Penicillins / therapeutic use
Pregnancy
Retrospective Studies
Risk Factors
Sepsis / epidemiology*,  etiology,  mortality,  prevention & control
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Penicillins; 69-53-4/Ampicillin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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