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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 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 [less than or equal to] 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 ([less than or equal to] 33 weeks), intrapartum fever, and membrane rupture of [greater than or equal to] 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 [greater than or equal to] 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 [greater than or equal to] 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. Key Words neonate, perinatal infection, ampicillin, preterm delivery, chemoprophylaxis, sepsis Abbreviations GBS--group B streptococcus ABCs--Active Bacterial Core Surveillance CI--confidence interval OR--odds ratio aOR--adjusted odds ratio, NEONATAL SEPSIS IS a leading infectious cause of infant morbidity and death. Group B streptococcal (GBS) sepsis emerged in the 1970s as a predominant cause of infections in the first [...]

Objective. Although increased use of intrapartum antibiotics caused significant declines in early-onset group B Streptococcus (GBS) infection, the effect on infections caused by other pathogens is not clear. The objective of this study was to determine trends in the incidence of early-onset sepsis caused by organisms other than group B streptococcus in the era of antimicrobial prophylaxis. Methods. We conducted surveillance for early-onset sepsis as part of the Active Bacterial Core surveillance. A case was defined as isolation of bacteria from blood or cerebrospinal fluid from an infant who was 0 to 6 days of age and born in the surveillance area during 1998 through 2000 (248 184 births). Results. We identified 408 cases of early-onset infection. GBS caused 166 (40.7%) cases (52 in 1998, 51 in 1999, and 63 in 2000 for incidences 0.62, 0.62, and 0.76 cases per 1000 live births, respectively). Other bacterial pathogens were identified in 242 cases (82 in 1998, 79 in 1999, and 81 in 2000 for incidences 0.99, 0.95, and 0.98 per 1000 live births, respectively) of early-onset sepsis. Escherichia coli caused 70 cases (0.25, 0.28, and 0.31 cases per 1000 live births, respectively, in 1998-2000). The proportion of E coli infections that were resistant to ampicillin increased significantly among preterm infants from 29% (2 of 7) in 1998 to 84% (16 of 18) in 2000 but not in full-term infants: 50% (4 of 8) in 1998 and 25% (1 of 4) in 2000. Conclusions. Whereas rates of early-onset sepsis caused by GBS and other pathogens were low and did not change significantly during the study period, antibiotic-resistant E coli infections among preterm infants increased. Overall, these trends are reassuring, but careful evaluation of the increase in resistant infections in very young infants is critical in the future. Pediatrics 2002;110:690-695; neonatal sepsis, group B Streptococcus, guidelines, surveillance, Escherichia coli, antimicrobial resistance., ABBREVIATIONS. GBS, group B Streptococcus; CSF, cerebrospinal fluid. Bacterial infection during the first 7 days of life, or early-onset infection, places an infant at risk for death or long-term disability. [...]

Objective. To determine whether intrapartum antibiotic prophylaxis for neonatal group B streptococcal (GBS) disease has resulted in an increased rate of non-GBS or antibiotic-resistant early-onset invasive neonatal disease. Methods. Maternal and infant chart review of all infants with bacteria other than GBS isolated from blood or spinal fluid in 1996 through 1999 in 19 hospitals (representing 81% of in-state births to state residents) throughout Connecticut. Suspected cases were identified through clinical microbiology laboratory records or through International Classification of Diseases, Ninth Revision codes when microbiology records were incomplete. Results. Ninety-four cases of non-GBS early-onset sepsis or meningitis were detected between 1996 and 1999. The rate of GBS-related early-onset infection (days 0-6 of life) dropped from 0.61/1000 to 0.23/1000 births, but the annual rate of non-GBS sepsis remained steady, ranging from 0.65 to 0.68/1000 during the surveillance period. There was an increase in the proportion of Escherichia coli infections that were ampicillin resistant between 1996 and 1998, but the proportion decreased, in 1999 Conclusion. There was no increase in the incidence of non-GBS early-onset neonatal infections between 1996 and 1999. Fluctuations in the annual incidence of E coli infections, including ampicillin-resistant infections, suggest the need for continuation of surveillance in Connecticut and expansion to monitor larger populations. Pediatrics 2001;108:1094-1098; neonatal infections, sepsis, bacterial infections, bacterial infections/cause, bacterial infections/prevention and control, infant, premature, newborn., ABBREVIATIONS. NICU, neonatal intensive care unit; GBS, group B Streptococcus (streptococcal); CDC, Centers for Disease Control and Prevention. Neonatal sepsis occurs at an estimated rate of 1 to 2 cases [...]