Risk factors and opportunities for prevention of early-onset neonatal sepsis: A multicenter case-control study

Anne Schuchat, Sara S. Zywicki, Mara J. Dinsmoor, Brian Mercer, Josefina Romaguera, Mary Jo O'Sullivan, Daksha Patel, Mark T. Peters, Barbara Stoll, Orin S. Levine

Research output: Contribution to journalArticle

247 Citations (Scopus)

Abstract

Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) and Escherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-matched controls without documented sepsis, GBS disease was associated with intrapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1-8.0). 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. No deaths occurred among susceptible E coli infections, whereas 41% of ampicillin-resistant E coli infections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59% of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin- resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis.

Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalPediatrics
Volume105
Issue number1 I
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Case-Control Studies
Sepsis
Escherichia coli Infections
Antibiotic Prophylaxis
Ampicillin
Parturition
Fever
Mothers
Neonatal Sepsis
Escherichia coli
Ampicillin Resistance
Gynecological Examination
Live Birth
Infection
Premature Infants
Penicillins
Obstetrics
Rupture
Anti-Bacterial Agents
Pregnancy

Keywords

  • Antibiotic resistance
  • Escherichia coli
  • Group B streptococcal
  • Meningitis
  • Neonatal sepsis
  • Risk factors
  • Streptococcal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Schuchat, A., Zywicki, S. S., Dinsmoor, M. J., Mercer, B., Romaguera, J., O'Sullivan, M. J., ... Levine, O. S. (2000). Risk factors and opportunities for prevention of early-onset neonatal sepsis: A multicenter case-control study. Pediatrics, 105(1 I), 21-26.

Risk factors and opportunities for prevention of early-onset neonatal sepsis : A multicenter case-control study. / Schuchat, Anne; Zywicki, Sara S.; Dinsmoor, Mara J.; Mercer, Brian; Romaguera, Josefina; O'Sullivan, Mary Jo; Patel, Daksha; Peters, Mark T.; Stoll, Barbara; Levine, Orin S.

In: Pediatrics, Vol. 105, No. 1 I, 01.01.2000, p. 21-26.

Research output: Contribution to journalArticle

Schuchat, A, Zywicki, SS, Dinsmoor, MJ, Mercer, B, Romaguera, J, O'Sullivan, MJ, Patel, D, Peters, MT, Stoll, B & Levine, OS 2000, 'Risk factors and opportunities for prevention of early-onset neonatal sepsis: A multicenter case-control study', Pediatrics, vol. 105, no. 1 I, pp. 21-26.
Schuchat A, Zywicki SS, Dinsmoor MJ, Mercer B, Romaguera J, O'Sullivan MJ et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: A multicenter case-control study. Pediatrics. 2000 Jan 1;105(1 I):21-26.
Schuchat, Anne ; Zywicki, Sara S. ; Dinsmoor, Mara J. ; Mercer, Brian ; Romaguera, Josefina ; O'Sullivan, Mary Jo ; Patel, Daksha ; Peters, Mark T. ; Stoll, Barbara ; Levine, Orin S. / Risk factors and opportunities for prevention of early-onset neonatal sepsis : A multicenter case-control study. In: Pediatrics. 2000 ; Vol. 105, No. 1 I. pp. 21-26.
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abstract = "Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) and Escherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-matched controls without documented sepsis, GBS disease was associated with intrapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1-8.0). 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. No deaths occurred among susceptible E coli infections, whereas 41{\%} of ampicillin-resistant E coli infections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59{\%} of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin- resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis.",
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T1 - Risk factors and opportunities for prevention of early-onset neonatal sepsis

T2 - A multicenter case-control study

AU - Schuchat, Anne

AU - Zywicki, Sara S.

AU - Dinsmoor, Mara J.

AU - Mercer, Brian

AU - Romaguera, Josefina

AU - O'Sullivan, Mary Jo

AU - Patel, Daksha

AU - Peters, Mark T.

AU - Stoll, Barbara

AU - Levine, Orin S.

PY - 2000/1/1

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N2 - Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) and Escherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-matched controls without documented sepsis, GBS disease was associated with intrapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1-8.0). 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. No deaths occurred among susceptible E coli infections, whereas 41% of ampicillin-resistant E coli infections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59% of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin- resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis.

AB - Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) and Escherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-matched controls without documented sepsis, GBS disease was associated with intrapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1-8.0). 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. No deaths occurred among susceptible E coli infections, whereas 41% of ampicillin-resistant E coli infections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59% of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin- resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis.

KW - Antibiotic resistance

KW - Escherichia coli

KW - Group B streptococcal

KW - Meningitis

KW - Neonatal sepsis

KW - Risk factors

KW - Streptococcal

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