1. Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management?
- Author
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Alberto Berardi, Viola Trevisani, Antonella Di Caprio, Paola Caccamo, Giuseppe Latorre, Sabrina Loprieno, Alessandra Foglianese, Nicola Laforgia, Barbara Perrone, Giangiacomo Nicolini, Matilde Ciccia, Maria Grazia Capretti, Chiara Giugno, Vittoria Rizzo, Daniele Merazzi, Silvia Fanaro, Lucia Taurino, Rita Maria Pulvirenti, Silvia Orlandini, Cinzia Auriti, Cristina Haass, Laura Ligi, Giulia Vellani, Chryssoula Tzialla, Cristina Tuoni, Daniele Santori, Lorenza Baroni, Mariachiara China, Jenny Bua, Federica Visintini, Lidia Decembrino, Roberta Creti, Francesca Miselli, Luca Bedetti, and Licia Lugli
- Subjects
intrapartum antibiotic prophylaxis ,early-onset sepsis ,newborn ,prevention ,group B streptococcus ,Escherichia coli ,Medicine - Abstract
The effectiveness of “inadequate” intrapartum antibiotic prophylaxis (IAP administered < 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003–2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined “active” when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an “inactive” IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP “adequate” seems the pathogen’s antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.
- Published
- 2023
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