Risk Factors for Invasive, Early-Onset Escherichia coli Infections in the Era of Widespread Intrapartum Antibiotic Use

OBJECTIVE. The goal was to evaluate risk factors for invasive Escherichia coli infections in the first week of life (early onset), focusing on the role of intrapartum antibiotic use. METHODS. We conducted a retrospective case-control study. Between 1997 and 2001, case infants, defined as infants <7 days of age with E coli isolated from blood or cerebrospinal fluid, were identified in selected counties of California, Georgia, and Connecticut by the Active Bacterial Core Surveillance/Emerging Infections Program Network. Control infants (N = 1212) were identified from a labor and delivery record review of a stratified random sample of live births at the same hospitals in 1998 and 1999. RESULTS. Surveillance identified 132 E coli cases, including 68 ampicillin-resistant cases. The case fatality rate was 16% (21 of 132 cases). Two thirds of case infants were preterm, and 49% (64 of 132 infants) were born at ≤33 weeks of gestation. Fifty-three percent of case mothers (70 of 132 mothers) received intrapartum antibiotic therapy; 70% of those received ampicillin or penicillin. Low gestational age (≤33 weeks), intrapartum fever, and membrane rupture of ≥18 hours were associated with increased odds of early-onset E coli infection. Results were similar when case subjects were limited to those infected with ampicillin-resistant strains. Exposure to any intrapartum antibiotic treatment, β-lactam antibiotic treatment, or ≥4 hours of intrapartum antibiotic therapy was associated with increased odds of E coli infection and ampicillin-resistant infection in univariate analyses. Among preterm infants, intrapartum antibiotic exposure did not remain associated with either outcome in multivariable models. Among term infants, exposure to ≥4 hours of intrapartum antibiotic therapy was associated with decreased odds of early-onset E coli infection. CONCLUSIONS. Exposure to intrapartum antibiotic therapy did not increase the odds of invasive, early-onset E coli infection. Intrapartum antibiotic therapy was effective in preventing E coli infection only among term infants.

[1]  B. Stoll,et al.  Very Low Birth Weight Preterm Infants With Early Onset Neonatal Sepsis: The Predominance of Gram-Negative Infections Continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002–2003 , 2005, The Pediatric infectious disease journal.

[2]  J. L. López Sastre,et al.  Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention , 2005, Acta paediatrica.

[3]  Early-onset and late-onset neonatal group B streptococcal disease--United States, 1996-2004. , 2005, MMWR. Morbidity and mortality weekly report.

[4]  D. Isaacs,et al.  Ten-Year Study on the Effect of Intrapartum Antibiotic Prophylaxis on Early Onset Group B Streptococcal and Escherichia coli Neonatal Sepsis in Australasia , 2004, The Pediatric infectious disease journal.

[5]  A. Alarcon,et al.  Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis , 2004, The Pediatric infectious disease journal.

[6]  R. Goldenberg,et al.  Infection as a cause of preterm birth. , 2003, Clinics in perinatology.

[7]  A. Schuchat,et al.  Prenatal screening for infectious diseases and opportunities for prevention. , 2003, Obstetrics and gynecology.

[8]  A. Schuchat,et al.  Effects of intrapartum antimicrobial prophylaxis for prevention of group-B-streptococcal disease on the incidence and ecology of early-onset neonatal sepsis. , 2003, The Lancet. Infectious diseases.

[9]  R. Edwards,et al.  Intrapartum Antibiotic Prophylaxis and Early-Onset Neonatal Sepsis Patterns , 2003, Infectious diseases in obstetrics and gynecology.

[10]  F. Baquero,et al.  Antibiotic resistance in 1962 invasive isolates of Escherichia coli in 27 Spanish hospitals participating in the European Antimicrobial Resistance Surveillance System (2001). , 2002, The Journal of antimicrobial chemotherapy.

[11]  K. O'Brien,et al.  Trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta. , 2002, Pediatrics.

[12]  N. Frimodt-Møller,et al.  Susceptibility of Danish Escherichia coli strains isolated from urinary tract infections and bacteraemia, and distribution of sul genes conferring sulphonamide resistance. , 2002, The Journal of antimicrobial chemotherapy.

[13]  G. Briggs,et al.  Antepartum use of antibiotics and early-onset neonatal sepsis: the next 4 years. , 2002, American journal of obstetrics and gynecology.

[14]  J. Karlowsky,et al.  Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States , 2002, Antimicrobial Agents and Chemotherapy.

[15]  W. Poole,et al.  Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. , 2002, The New England journal of medicine.

[16]  A. Schuchat,et al.  A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. , 2002, The New England journal of medicine.

[17]  K. O'Brien,et al.  Early-onset neonatal sepsis in the era of group B streptococcal prevention. , 2001, Pediatrics.

[18]  A. Schuchat,et al.  Group B Streptococcal Disease Prevention Practices of Obstetrician‐Gynecologists , 2001, Obstetrics and gynecology.

[19]  G. Thurnau,et al.  The preterm prediction study: cervical lactoferrin concentration, other markers of lower genital tract infection, and preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. , 2000, American journal of obstetrics and gynecology.

[20]  A. Schuchat,et al.  Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. , 2000, The New England journal of medicine.

[21]  B. Stoll,et al.  Risk Factors and Opportunities for Prevention of Early-Onset Neonatal Sepsis: A Multicenter Case-Control Study , 1999, Pediatrics.

[22]  Michael,et al.  Generalized Population Attributable Risk Estimation , 2000 .

[23]  Lisa B. Gelling,et al.  Hospital-based policies for prevention perinatal Group B streptococcal disease--United States, 1999. , 2000, MMWR. Morbidity and mortality weekly report.

[24]  J. L. López Sastre,et al.  Neonatal sepsis of vertical transmission: an epidemiological study from the "Grupo de Hospitales Castrillo". , 2000, Journal of perinatal medicine.

[25]  B. Sibai,et al.  Antibiotic use in pregnancy and drug-resistant infant sepsis. , 1999, American journal of obstetrics and gynecology.

[26]  J. N. Martin,et al.  Neonatal sepsis and death caused by resistant Escherichia coli: possible consequences of extended maternal ampicillin administration. , 1999, American journal of obstetrics and gynecology.

[27]  N. F. Jacobs,et al.  Neonatal early-onset Escherichia coli disease. The effect of intrapartum ampicillin. , 1998, Archives of pediatrics & adolescent medicine.

[28]  B. Frentzen,et al.  Risk Factors for Neonatal Sepsis , 1996, Obstetrics and gynecology.

[29]  Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. , 1986, The New England journal of medicine.