BACKGROUND: Antibiotic administration during pregnancy as group B Streptococcus prophylaxis or as treatment of maternal conditions has become widespread. OBJECTIVE: To assess whether bacterial type and antibiotic resistance in early-onset neonatal sepsis are associated with maternal antibiotic use. METHODS: All positive blood and/or cerebrospinal fluid cultures (case-only study) and respective antibiotic sensitivities from newborns delivered in Shaare Zedek Medical Center, Jerusalem, Israel, between 01/01/1997 and 31/01/2007, taken during the first 72 h of life, were studied. Clinical and demographic data were obtained from the medical records of the infant/mother dyads. Three groups were defined by type of maternal antibiotic exposure: (1) no exposure, (2) intrapartum antibiotic prophylaxis (IAP), (3) antepartum antibiotic exposure during the month prior to delivery and extending into delivery or with subsequent IAP (AAE). Factors potentially associated with Gram-negative bacteremia and resistance to ampicillin were analyzed using multivariate logistic regression. RESULTS: Ninety-seven different organisms grew from 94 infants (1.03 per 1,000 live births). By univariate analysis, AAE, gestational age ≤ 32 weeks, chorioamnionitis and rupture of membranes ≥ 18 h, were significantly associated with both Gram-negative sepsis and antibiotic resistance. By multivariate analysis, AAE was significantly associated with both outcomes, while gestational age ≤32 weeks was only associated with antibiotic resistance. CONCLUSIONS: AAE for more than 24 h is associated with an increased proportion of Gram-negative organisms and ampicillin resistance in early-onset neonatal sepsis. Antepartum antibiotic therapy and its ramifications need to be continuously monitored and prospectively studied.
BACKGROUND: Antibiotic administration during pregnancy as group B Streptococcus prophylaxis or as treatment of maternal conditions has become widespread. OBJECTIVE: To assess whether bacterial type and antibiotic resistance in early-onset neonatal sepsis are associated with maternal antibiotic use. METHODS: All positive blood and/or cerebrospinal fluid cultures (case-only study) and respective antibiotic sensitivities from newborns delivered in Shaare Zedek Medical Center, Jerusalem, Israel, between 01/01/1997 and 31/01/2007, taken during the first 72 h of life, were studied. Clinical and demographic data were obtained from the medical records of the infant/mother dyads. Three groups were defined by type of maternal antibiotic exposure: (1) no exposure, (2) intrapartum antibiotic prophylaxis (IAP), (3) antepartum antibiotic exposure during the month prior to delivery and extending into delivery or with subsequent IAP (AAE). Factors potentially associated with Gram-negative bacteremia and resistance to ampicillin were analyzed using multivariate logistic regression. RESULTS: Ninety-seven different organisms grew from 94 infants (1.03 per 1,000 live births). By univariate analysis, AAE, gestational age ≤ 32 weeks, chorioamnionitis and rupture of membranes ≥ 18 h, were significantly associated with both Gram-negative sepsis and antibiotic resistance. By multivariate analysis, AAE was significantly associated with both outcomes, while gestational age ≤32 weeks was only associated with antibiotic resistance. CONCLUSIONS: AAE for more than 24 h is associated with an increased proportion of Gram-negative organisms and ampicillin resistance in early-onset neonatal sepsis. Antepartum antibiotic therapy and its ramifications need to be continuously monitored and prospectively studied.
Authors: Stephen P Bergin; Joshua T Thaden; Jessica E Ericson; Heather Cross; Julia Messina; Reese H Clark; Vance G Fowler; Daniel K Benjamin; Christoph P Hornik; P Brian Smith Journal: Pediatr Infect Dis J Date: 2015-09 Impact factor: 3.806
Authors: Lola Madrid; Anna C Seale; Maya Kohli-Lynch; Karen M Edmond; Joy E Lawn; Paul T Heath; Shabir A Madhi; Carol J Baker; Linda Bartlett; Clare Cutland; Michael G Gravett; Margaret Ip; Kirsty Le Doare; Craig E Rubens; Samir K Saha; Ajoke Sobanjo-Ter Meulen; Johan Vekemans; Stephanie Schrag Journal: Clin Infect Dis Date: 2017-11-06 Impact factor: 20.999