NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
3-035 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
Early Sepsis in VLBW Infants
Changes in Pathogens Causing Early-Onset Sepsis in Very-Low-Birth-Weight Infants. Stoll BJ, Hansen N, Fanaroff AA, et al. N Engl J Med (July 25, 2002);347: 240-7.
We studied 5447 very-low-birth-weight infants (those weighing between 401 and 1500 g) born between 1998 and 2000 who had at least one blood culture in the first three days of life and compared them with 7606 very-low-birth-weight infants born between 1991 and 1993.
Results. Early-onset sepsis (as confirmed by positive blood cultures) was present in 84 infants in the more recent birth cohort (1.5 percent). As compared with the earlier birth cohort, there was a marked reduction in group B streptococcal sepsis (from 5.9 to 1.7 per 1000 live births of infants weighing 401 to 1500 g, P<0.001) and an increase in Escherichia coli sepsis (from 3.2 to 6.8 per 1000 live births, P=0.004); the overall rate of early-onset sepsis was not significantly changed. Most E. coli isolates from the recent birth cohort (85 percent) were resistant to ampicillin, and mothers of infants with ampicillin-resistant E. coli infections were more likely to have received intrapartum ampicillin than were those with ampicillin-sensitive strains (26 of 28 with sensitivity data vs. 1 of 5, P=0.01). Infants with early-onset sepsis were more likely to die than uninfected infants (37 percent vs. 13 percent, P<0.001), especially if they were infected with gram-negative organisms.
Comment. We should be concerned that our efforts to prevent early-onset GBS sepsis with intrapartum antibiotic prophylaxis might result in a shift in VLBW infants to infections with more-virulent gram negative organisms such as ampicillin-resistant E. coli. Perhaps we should consider adding antibiotics with better gram negative coverage when giving prophylaxis to mothers in preterm labor. ABK
Additional Comments: You may add your own comments to the discussion of this topic by selecting : Submit Comments.