Changes in Pathogens Causing Early-Onset Sepsis in Very-Low-Birth-Weight Infants
Barbara J. Stoll, M.D., Nellie Hansen, M.P.H., Avroy A. Fanaroff, M.D., Linda L. Wright, M.D., Waldemar A. Carlo, M.D., Richard A. Ehrenkranz, M.D., James A. Lemons, M.D., Edward F. Donovan, M.D., Ann R. Stark, M.D., Jon E. Tyson, M.D., M.P.H., William Oh, M.D., Charles R. Bauer, M.D., Sheldon B. Korones, M.D., Seetha Shankaran, M.D., Abbot R. Laptook, M.D., David K. Stevenson, M.D., Lu-Ann Papile, M.D., and W. Kenneth Poole, Ph.D.
Background It is uncertain whether the rates and causes of early-onsetsepsis (that occurring within 72 hours after birth) among very-low-birth-weightinfants have changed in recent years, since antibiotics havebegun to be used more widely during labor and delivery.
Methods We studied 5447 very-low-birth-weight infants (thoseweighing between 401 and 1500 g) born at centers of the NeonatalResearch Network of the National Institute of Child Health andHuman Development between 1998 and 2000 who had at least oneblood culture in the first three days of life and compared themwith 7606 very-low-birth-weight infants born at centers in thenetwork 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 (1.5percent). As compared with the earlier birth cohort, there wasa marked reduction in group B streptococcal sepsis (from 5.9to 1.7 per 1000 live births of infants weighing 401 to 1500g, P<0.001) and an increase in Escherichia coli sepsis (from3.2 to 6.8 per 1000 live births, P=0.004); the overall rateof early-onset sepsis was not significantly changed. Most E.coli isolates from the recent birth cohort (85 percent) wereresistant to ampicillin, and mothers of infants with ampicillin-resistantE. coli infections were more likely to have received intrapartumampicillin than were those with ampicillin-sensitive strains(26 of 28 with sensitivity data vs. 1 of 5, P=0.01). Infantswith early-onset sepsis were more likely to die than uninfectedinfants (37 percent vs. 13 percent, P<0.001), especiallyif they were infected with gram-negative organisms.
Conclusions Early-onset sepsis remains an uncommon but potentiallylethal problem among very-low-birth-weight infants. The changein pathogens over time from predominantly gram-positive to predominantlygram-negative requires confirmation by ongoing surveillance.
Source Information
From the Department of Pediatrics, Emory University School of Medicine, Atlanta (B.J.S.); Research Triangle Institute, Research Triangle Park, N.C. (N.H., W.K.P.); the Department of Pediatrics, Case Western Reserve University, Cleveland (A.A.F.); the National Institute of Child Health and Human Development, Bethesda, Md. (L.L.W.); the Department of Pediatrics, University of Alabama, Birmingham (W.A.C.); the Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. (R.A.E.); the Department of Pediatrics, Indiana University School of Medicine, Indianapolis (J.A.L.); the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati (E.F.D.); the Department of Newborn Medicine, Brigham and Women's Hospital, Boston (A.R.S.); the University of Texas at Houston, Houston (J.E.T.); Women and Infant's Hospital, Providence, R.I. (W.O.); the Department of Pediatrics, University of Miami, Miami (C.R.B.); the Newborn Center, University of Tennessee–Memphis, Memphis (S.B.K.); the Division of Neonatal and Perinatal Medicine, Wayne State University, Detroit (S.S.); the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (A.R.L.); the Division of Neonatology, Stanford University Medical Center, Palo Alto, Calif. (D.K.S.); and the Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque (L.-A.P.).
Address reprint requests to Dr. Stoll at the Department of Pediatrics, Emory University School of Medicine, 2040 Ridgewood Dr., NE, Atlanta, GA 30322.
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