Abstract
Objective: To compare the relative effects of intrapartum antibiotic prophylaxis regimens on patterns of early-onset neonatal sepsis.
Methods: We performed an historical cohort study of 17 187 infants born at our center from September 1993 to February 2000. A risk-based strategy was employed prior to July 1996 and a screening-based strategy was utilized thereafter. Ampicillin was utilized prior to March 1995 and penicillin was used thereafter.
Results: There were 75 cases of neonatal sepsis, 34 (4.10/1000) in the risk-based era and 41 (4.63/1000) in the screening-based era (p = 0.62). There were fewer ampicillin-resistant isolates during the risk-based than the screening-based era (32 versus 61%; p = 0.014). The only significant change in organism-specific sepsis rates was an increase in the rate of infection caused by coagulase-negative staphylococci in the screening-based era (0.36 versus 1.46/1000; p = 0.018), but 75% of infants infected with these organisms were not exposed to ß-lactam antibiotics within 72 h prior to delivery. For the risk- and screening-based eras, respectively, the rates of Gram-negative sepsis (1.21 versus 1.46/1000; p = 0.65) and the proportions of Gram-negative pathogens that were ampicillin-resistant (70 versus 77%; p = 1.0) were similar. The drug employed for prophylaxis did not appear to affect the pattern of sepsis cases.
Conclusion: In our patient population, coagulase-negative staphylococci have become the most common cause of early-onset neonatal sepsis. The cause of this shift in pathogen prevalence is uncertain and seemingly unrelated to intrapartum antibiotic exposure.
Full Text
The Full Text of this article is available as a PDF (300.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baltimore R. S., Huie S. M., Meek J. I., Schuchat A., O'Brien K. L. Early-onset neonatal sepsis in the era of group B streptococcal prevention. Pediatrics. 2001 Nov;108(5):1094–1098. doi: 10.1542/peds.108.5.1094. [DOI] [PubMed] [Google Scholar]
- Chen K. T., Tuomala R. E., Cohen A. P., Eichenwald E. C., Lieberman E. No increase in rates of early-onset neonatal sepsis by non-group B Streptococcus or ampicillin-resistant organisms. Am J Obstet Gynecol. 2001 Oct;185(4):854–858. doi: 10.1067/mob.2001.117354. [DOI] [PubMed] [Google Scholar]
- Edwards Rodney K., Clark Penny, Sistrom Christopher L., Duff Patrick. Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens. Obstet Gynecol. 2002 Sep;100(3):534–539. doi: 10.1016/s0029-7844(02)02096-3. [DOI] [PubMed] [Google Scholar]
- Joseph T. A., Pyati S. P., Jacobs N. Neonatal early-onset Escherichia coli disease. The effect of intrapartum ampicillin. Arch Pediatr Adolesc Med. 1998 Jan;152(1):35–40. doi: 10.1001/archpedi.152.1.35. [DOI] [PubMed] [Google Scholar]
- Levine E. M., Ghai V., Barton J. J., Strom C. M. Intrapartum antibiotic prophylaxis increases the incidence of gram-negative neonatal sepsis. Infect Dis Obstet Gynecol. 1999;7(4):210–213. doi: 10.1002/(SICI)1098-0997(1999)7:4<210::AID-IDOG10>3.0.CO;2-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Locksmith G. J., Clark P., Duff P. Maternal and neonatal infection rates with three different protocols for prevention of group B streptococcal disease. Am J Obstet Gynecol. 1999 Feb;180(2 Pt 1):416–422. doi: 10.1016/s0002-9378(99)70225-5. [DOI] [PubMed] [Google Scholar]
- Schrag S. J., Zywicki S., Farley M. M., Reingold A. L., Harrison L. H., Lefkowitz L. B., Hadler J. L., Danila R., Cieslak P. R., Schuchat A. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med. 2000 Jan 6;342(1):15–20. doi: 10.1056/NEJM200001063420103. [DOI] [PubMed] [Google Scholar]
- Schrag Stephanie J., Zell Elizabeth R., Lynfield Ruth, Roome Aaron, Arnold Kathryn E., Craig Allen S., Harrison Lee H., Reingold Arthur, Stefonek Karen, Smith Glenda. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med. 2002 Jul 25;347(4):233–239. doi: 10.1056/NEJMoa020205. [DOI] [PubMed] [Google Scholar]
- Schuchat A. Group B streptococcal disease: from trials and tribulations to triumph and trepidation. Clin Infect Dis. 2001 Aug 10;33(6):751–756. doi: 10.1086/322697. [DOI] [PubMed] [Google Scholar]
- Towers C. V., Carr M. H., Padilla G., Asrat T. Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol. 1998 Oct;179(4):879–883. doi: 10.1016/s0002-9378(98)70182-6. [DOI] [PubMed] [Google Scholar]