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Updated: Jul 27, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Incidence of infant Gram-negative invasive bacterial infections in England, 2011-2019: an observational study using
Luisa K Hallmaier-Wacker1, Amelia Andrews2, Russell Hope1
1Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK.
Insights
Invasive bacterial infections in infants rose significantly in England from 2011-2019, primarily due to late-onset cases. This trend highlights a growing concern for infant health and necessitates further research into prevention strategies.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health Surveillance
Background:
- Invasive bacterial infections (IBIs) are a major cause of infant mortality globally.
- Gram-negative pathogens are significant contributors to infant morbidity and mortality.
Purpose of the Study:
- To estimate the incidence and trends of Gram-negative pathogen-associated IBIs in infants in England.
- To analyze changes in early-onset versus late-onset infections and polymicrobial infections.
Main Methods:
- Utilized UK Health Security Agency national laboratory surveillance data for infants (<1 year) from April 2011 to March 2019.
- Defined early-onset (<7 days) and late-onset (≥7 days) infections, and polymicrobial infections (≥2 species).
- Employed Poisson and beta regression for trend analyses of incidence and proportions.
Main Results:
- Annual incidence of IBIs increased by 35.9% (189.8 to 258.0 per 100,000 live births).
- Late-onset infections showed a substantial increase in both neonates and infants (p<0.001).
- Escherichia coli was the leading pathogen, and polymicrobial infections nearly doubled.
Conclusions:
- Gram-negative IBIs in infants have increased in England, primarily driven by late-onset infections.
- Further research is needed to identify risk factors and drivers for prevention.
- The rise in polymicrobial infections warrants specific attention.
Objective:
Invasive bacterial infections account for an estimated 15% of infant deaths worldwide. We aimed to estimate the incidence and trends in invasive bacterial infections in infants caused by Gram-negative pathogens in England during 2011-2019.
Methods:
Laboratory-confirmed invasive bacterial infections in infants (<1 year old) were identified in the UK Health Security Agency national laboratory surveillance data from April 2011 to March 2019. Polymicrobial infections were defined as two or more bacterial species from the same normally sterile sample site. Early-onset infections were defined as <7 days from birth and late-onset as ≥7 days (neonates 7-28 days; infants ≥29 days). Trend analyses were carried out using Poisson (for episodes/incidence) and beta (for proportions) regression.
Results:
The annual incidence of invasive bacterial infections increased by 35.9%, from 189.8 to 258.0 cases per 100 000 live births (p<0.001). Late-onset infections in both neonates and infants increased substantially over the study period (p<0.001), whereas early-onset infections increased slightly (p=0.002). Escherichia coli was the most common Gram-negative pathogen isolated and accounted for 27.2% of the overall rise in Gram-negative infant disease incidence. Polymicrobial infections almost doubled, increasing from 29.2 to 57.7 per 100 000 live births (p<0.001), and mostly involved two species (81.3%, 1604/1974 episodes).
Conclusions:
The incidence of Gram-negative invasive bacterial infections in infants increased between 2011/2012 and 2018/2019 in England, driven mainly by an increase in late-onset infections. Further work is required to elucidate the risk factors and drivers of this increased incidence so that opportunities for prevention can be identified.
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