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A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
Intrapartum antibiotic prophylaxis and early-onset neonatal sepsis patterns
Rodney K Edwards1, Whitney E Jamie, Donald Sterner
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0294, USA. edwardsr@obgyn.ufl.edu
Insights
Intrapartum antibiotic prophylaxis did not significantly alter early-onset neonatal sepsis patterns. Coagulase-negative staphylococci emerged as the leading cause, independent of antibiotic exposure.
Area of Science:
- Neonatal Health
- Infectious Diseases
- Pharmacology
Background:
- Early-onset neonatal sepsis (EONS) poses a significant threat to newborns.
- Intrapartum antibiotic prophylaxis (IAP) is a common intervention to prevent EONS.
- Understanding the impact of different IAP regimens on sepsis patterns is crucial for optimizing obstetric and neonatal care.
Purpose of the Study:
- To compare the effectiveness of different intrapartum antibiotic prophylaxis regimens in altering the patterns of early-onset neonatal sepsis.
- To investigate shifts in causative pathogens and antibiotic resistance associated with evolving IAP strategies.
Main Methods:
- Historical cohort study of 17,187 infants born between September 1993 and February 2000.
- Comparison of a risk-based IAP strategy (pre-July 1996) with a screening-based strategy (post-July 1996).
- Analysis of antibiotic use (ampicillin vs. penicillin) and its correlation with sepsis patterns and pathogen resistance.
Main Results:
- Overall EONS rates were similar between risk-based (4.10/1000) and screening-based (4.63/1000) eras (p=0.62).
- Ampicillin resistance increased significantly from the risk-based to the screening-based era (32% vs. 61%, p=0.014).
- Coagulase-negative staphylococci became the most common cause of EONS in the screening-based era (1.46/1000 vs. 0.36/1000, p=0.018), often in infants not exposed to beta-lactams.
Conclusions:
- The shift in pathogen prevalence towards coagulase-negative staphylococci in EONS appears unrelated to intrapartum antibiotic exposure.
- Current IAP strategies may not be effectively preventing EONS caused by this emerging pathogen.
- Further research is needed to understand the drivers of this shift and develop targeted prevention strategies.
Objective:
To compare the relative effects of intrapartum antibiotic prophylaxis regimens on patterns of early-onset neonatal sepsis.
Methods:
We performed an historical cohort study of 17187 infants born at our center from September 1993 to February 2000. A risk-based strategy was employed prior to July 1996 and a screening-based strategy was utilized thereafter. Ampicillin was utilized prior to March 1995 and penicillin was used thereafter.
Results:
There were 75 cases of neonatal sepsis, 34 (4. 10/1000) in the risk-based era and 41 (4.63/1000) in the screening-based era (p = 0.62). There were fewer ampicillin-resistant isolates during the risk-based than the screening-based era (32 versus 61%; p = 0.014). The only significant change in organism-specific sepsis rates was an increase in the rate of infection caused by coagulase-negative staphylococci in the screening-based era (0.36 versus 1.46/1000; p = 0.018), but 75% of infants infected with these organisms were not exposed to beta-lactam antibiotics within 72 h prior to delivery. For the risk- and screening-based eras, respectively, the rates of Gram-negative sepsis (1.21 versus 1.46/1000; p = 0.65) and the proportions of Gram-negative pathogens that were ampicillin-resistant (70 versus 77%; p = 1.0) were similar. The drug employed for prophylaxis did not appear to affect the pattern of sepsis cases.
Conclusion:
In our patient population, coagulase-negative staphylococci have become the most common cause of early-onset neonatal sepsis. The cause of this shift in pathogen prevalence is uncertain and seemingly unrelated to intrapartum antibiotic exposure.
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