1-001 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
Risk Factors and Opportunities for Prevention of Early-onset Neonatal Sepsis: A multicenter Case-Control Study. Schuchat A, Zywicki SS, Dinsmoor MJ et al. Pediatrics 2000;105:21-26.
This study by the Prevention of Early-onset Neonatal Sepsis (PENS) Study Group reports the results of a multicenter surveillance during 1995 to 1996 for culture confirmed early-onset sepsis in an aggregate of 52,406 births. Early-onset sepsis occurred in 188 infants (3.5 cases / 1000 live births). GBS (1.4 per 1000) and E. coli (0.6 per 1000) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. An obstetric risk factor - preterm delivery, intrapartum fever, or membrane rupture >= 18 hours - was found in 49% of GBS cases and 79% of other sepsis. IAP had an adjusted efficacy of 68.2% against any early-onset sepsis. Ampicillin resistance was evident in 69% of E. coli infections. 41% of ampicillin-resistant E. coli infections were fatal. 91% of ampicillin-resistant E. coli infections occurred in preterm infants, and 59% of these infants were born to mothers who had received IAP.
Comment. It was reassuring (but not surprising) to see that IAP was successful in preventing a substantial portion of early-onset GBS sepsis cases when used with either the GBS screening or risk-based strategy. However, many of us have been concerned that widespread IAP for GBS disease would select for resistant organisms that might be more virulent than GBS. Well, the take-home message from this study is clear: WATCH OUT FOR THE EMERGENCE OF AMPICILLIN-RESISTANT E. COLI AS THE NEXT MAJOR PATHOGEN THAT CAUSES NEONATAL SEPSIS. This pathogen was far more lethal than GBS (41% vs 6.7% mortality), and premature babies were especially susceptible to this infection. Since most cases of resistant E coli sepsis occurred in babies whose mothers had received IAP, we need to be concerned that the use of intrapartum ampicillin is contributing to the emergence of this very virulent organism.