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Updated: Mar 10, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Epidemiology of Invasive Early-Onset Neonatal Sepsis, 2005 to 2014
Stephanie J Schrag1, Monica M Farley2,3, Susan Petit4
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; sjschrag@cdc.gov.
Insights
Group B Streptococcus (GBS) prophylaxis did not increase E coli sepsis in newborns. However, stable E coli infection rates and mortality highlight the need for new interventions to protect infants.
Area of Science:
- Neonatal infections
- Bacterial sepsis epidemiology
- Public health surveillance
Background:
- Group B Streptococcus (GBS) and Escherichia coli are primary causes of early-onset neonatal sepsis.
- Concerns existed that GBS intrapartum prophylaxis might increase E coli incidence.
Purpose of the Study:
- To assess the impact of GBS prophylaxis on E coli early-onset neonatal sepsis incidence.
- To evaluate trends in GBS and E coli sepsis from 2005 to 2014.
Main Methods:
- Active, laboratory, and population-based surveillance for culture-positive bacterial infections in neonates (0-2 days old).
- Data collected in Minnesota, Connecticut, California, and Georgia from 2005 to 2014.
- Incidence rates calculated using live birth denominators; trend analysis via Cochran-Amitage test.
Main Results:
- 1484 cases identified: GBS (532), E coli (368), viridans streptococci (280).
- All-cause and E coli sepsis incidence remained stable; GBS incidence decreased.
- E coli sepsis had higher mortality odds in infants ≥1500g.
Conclusions:
- GBS prevention strategies have not increased early-onset E coli infections.
- Stable E coli sepsis burden and mortality necessitate further intervention development.
- Neonatal sepsis surveillance remains critical for monitoring bacterial pathogens.
Background:
Group B Streptococcus (GBS) and Escherichia coli have historically dominated as causes of early-onset neonatal sepsis. Widespread use of intrapartum prophylaxis for GBS disease led to concerns about the potential adverse impact on E coli incidence.
Methods:
Active, laboratory, and population-based surveillance for culture-positive (blood or cerebrospinal fluid) bacterial infections among infants 0 to 2 days of age was conducted statewide in Minnesota and Connecticut and in selected counties of California and Georgia during 2005 to 2014. Demographic and clinical information were collected and hospital live birth denominators were used to calculate incidence rates (per 1000 live births). We used the Cochran-Amitage test to assess trends.
Results:
Surveillance identified 1484 cases. GBS was most common (532) followed by E coli (368) and viridans streptococci (280). Eleven percent of cases died and 6.3% of survivors had sequelae at discharge. All-cause (2005: 0.79; 2014: 0.77; P = .05) and E coli (2005: 0.21; 2014: 0.18; P = .25) sepsis incidence were stable. GBS incidence decreased (2005: 0.27; 2014: 0.22; P = .02). Among infants <1500 g, incidence was an order of magnitude higher for both pathogens and stable. The odds of death among infants <1500 g were similar for both pathogens but among infants ≥1500 g, the odds of death were greater for E coli cases (odds ratio: 7.0; 95% confidence interval: 2.7-18.2).
Conclusions:
GBS prevention efforts have not led to an increasing burden of early-onset E coli infections. However, the stable burden of E coli sepsis and associated mortality underscore the need for interventions.
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