Alberto Berardi1, Lorenza Baroni2, Maria Letizia Bacchi Reggiani3, Simone Ambretti4, Giacomo Biasucci5, Serenella Bolognesi6, Maria Grazia Capretti7, Edoardo Carretto8, Matilde Ciccia9, Valentina Fiorini10, Cinzia Fortini11, Giancarlo Gargano2, Maria Federica Pedna12, Vittoria Rizzo13, Roberta Creti14, Fabrizio Ferrari1. 1. a Dipartimento Integrato Materno-Infantile , Azienda Ospedaliero-Universitaria Policlinico, Unità Operativa di Terapia Intensiva Neonatale , Modena , Italy . 2. b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy . 3. c Dipartimento Cardiovascolare , Azienda Ospedaliero-Universitaria S. Orsola-Malpighi , Bologna , Italy . 4. d Unità Operativa di Microbiologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi , Bologna , Italy . 5. e Unità Operativa di Pediatria, Ospedale G da Saliceto , Piacenza , Italy . 6. f Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi , Rimini , Italy . 7. g Unità Operativa di Neonatologia, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant'orsola - Malpighi , Bologna , Italy . 8. h Laboratorio di Microbiologia , Dipartimento Interaziendale di Diagnostica per Immagini e Medicina di Laboratorio, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy . 9. i Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile , Ospedale Maggiore , Bologna , Italy . 10. j Unità Operativa di Pediatria, Ospedale B Ramazzini , Carpi , Italy . 11. k Unità Operativa di Terapia Intensiva Neonatale, Ospedale S. Anna , Ferrara , Italy . 12. l Unità Operativa di Microbiologia, Laboratorio Unico Ausl della Romagna, Pievesestina Cesena , Italy . 13. m Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini , Cesena , Italy , and. 14. n Reparto di Malattie Batteriche, Respiratorie e Sistemiche, Dipartimento MIPI, Istituto Superiore di Sanità , Roma , Italy.
Abstract
OBJECTIVE: To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS. METHODS: Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed. RESULTS: Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight <1000 g (20.37/1000 LB and 8.49/1000 LB, respectively). The most common pathogens were GBS (n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coli EOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%). CONCLUSIONS: GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate.
OBJECTIVE: To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS. METHODS: Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed. RESULTS: Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight <1000 g (20.37/1000 LB and 8.49/1000 LB, respectively). The most common pathogens were GBS (n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coliEOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%). CONCLUSIONS:GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate.
Entities:
Keywords:
Early-onset sepsis; group B streptococcus; intrapartum chemoprophylaxis; meningitis; newborn infant
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