[Streptococcus pneumoniae neonatal infection]

One case of early onset invasive pneumococcal disease in the newborn, acquired from the maternal vagina, is reported. Streptococcus pneumoniae has been estimated to be rarely responsible for neonatal sepsis (1-8%) together with maternal infection. Clinical features are similar to other neonatal infections, but outcome is particularly severe (mortality: 50%, neurological sequelae: 13%). Newborn are most often infected from the maternal vagina that has been colonized with S. pneumoniae, despite the rarity of vaginal carriage of S. pneumoniae (yield in genital swabs from 0.03 to 0.75%). Severe outcome should lead to presumptive treatment (amoxicillin +/- vancomycin) of babies colonized with pneumococcus or born to colonized mother, even if asymptomatic, and, when necessary, of the mother. The rarity of the genital carriage, together with the difficulty to isolate S. pneumoniae from vaginal swabs makes unrealistic to systematically search for this organism. However, given the high ratio infection: colonization, greater significance should be attached to the discovery of vaginal colonization with pneumococcus in the pregnant or in the newborn in order to improve treatment and outcome.