The widespread use of intrapartum antibiotic prophylaxis (IAP) to prevent group B streptococcus (GBS) early-onset sepsis (EOS) is changing the epidemiology of EOS. Italian prospective area-based surveillance data (from 1 January 2016 to 31 December 2020) were used, from which we identified 64 cases of culture-proven EOS (E. coli, n = 39; GBS, n = 25) among 159,898 live births (annual incidence rates of 0.24 and 0.16 per 1000, respectively). Approximately 10% of E. coli isolates were resistant to both gentamicin and ampicillin. Five neonates died; among them, four were born very pre-term (E. coli, n = 3; GBS, n = 1) and one was born full-term (E. coli, n = 1). After adjustment for gestational age, IAP-exposed neonates had ≥95% lower risk of death, as compared to IAP-unexposed neonates, both in the whole cohort (OR 0.04, 95% CI 0.00-0.70; p = 0.03) and in the E. coli EOS cohort (OR 0.05, 95% CI 0.00-0.88; p = 0.04). In multi-variable logistic regression analysis, IAP was inversely associated with severe disease (OR = 0.12, 95% CI 0.02-0.76; p = 0.03). E. coli is now the leading pathogen in neonatal EOS, and its incidence is close to that of GBS in full-term neonates. IAP reduces the risk of severe disease and death. Importantly, approximately 10% of E. coli isolates causing EOS were found to be resistant to typical first-line antibiotics.

Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis / Miselli, Francesca; Cuoghi Costantini, Riccardo; Creti, Roberta; Sforza, Francesca; Fanaro, Silvia; Ciccia, Matilde; Piccinini, Giancarlo; Rizzo, Vittoria; Pasini, Lorena; Biasucci, Giacomo; Pagano, Rossella; Capretti, Mariagrazia; China, Mariachiara; Gambini, Lucia; Pulvirenti, Rita Maria; Dondi, Arianna; Lanari, Marcello; Pedna, Mariafederica; Ambretti, Simone; Lugli, Licia; Bedetti, Luca; Berardi, Alberto. - In: MICROORGANISMS. - ISSN 2076-2607. - 10:10(2022), p. 1878. [10.3390/microorganisms10101878]

Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis

Biasucci, Giacomo;Ambretti, Simone;
2022-01-01

Abstract

The widespread use of intrapartum antibiotic prophylaxis (IAP) to prevent group B streptococcus (GBS) early-onset sepsis (EOS) is changing the epidemiology of EOS. Italian prospective area-based surveillance data (from 1 January 2016 to 31 December 2020) were used, from which we identified 64 cases of culture-proven EOS (E. coli, n = 39; GBS, n = 25) among 159,898 live births (annual incidence rates of 0.24 and 0.16 per 1000, respectively). Approximately 10% of E. coli isolates were resistant to both gentamicin and ampicillin. Five neonates died; among them, four were born very pre-term (E. coli, n = 3; GBS, n = 1) and one was born full-term (E. coli, n = 1). After adjustment for gestational age, IAP-exposed neonates had ≥95% lower risk of death, as compared to IAP-unexposed neonates, both in the whole cohort (OR 0.04, 95% CI 0.00-0.70; p = 0.03) and in the E. coli EOS cohort (OR 0.05, 95% CI 0.00-0.88; p = 0.04). In multi-variable logistic regression analysis, IAP was inversely associated with severe disease (OR = 0.12, 95% CI 0.02-0.76; p = 0.03). E. coli is now the leading pathogen in neonatal EOS, and its incidence is close to that of GBS in full-term neonates. IAP reduces the risk of severe disease and death. Importantly, approximately 10% of E. coli isolates causing EOS were found to be resistant to typical first-line antibiotics.
2022
Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis / Miselli, Francesca; Cuoghi Costantini, Riccardo; Creti, Roberta; Sforza, Francesca; Fanaro, Silvia; Ciccia, Matilde; Piccinini, Giancarlo; Rizzo, Vittoria; Pasini, Lorena; Biasucci, Giacomo; Pagano, Rossella; Capretti, Mariagrazia; China, Mariachiara; Gambini, Lucia; Pulvirenti, Rita Maria; Dondi, Arianna; Lanari, Marcello; Pedna, Mariafederica; Ambretti, Simone; Lugli, Licia; Bedetti, Luca; Berardi, Alberto. - In: MICROORGANISMS. - ISSN 2076-2607. - 10:10(2022), p. 1878. [10.3390/microorganisms10101878]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2933049
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