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Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis.

Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG

Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520-8064, USA.

OBJECTIVE: The goal was to determine current trends in Escherichia coli-related early- and late-onset sepsis and patterns of ampicillin resistance in relation to institutional changes in the use of intrapartum antibiotic prophylaxis. METHODS: A retrospective review of data for all infants with E. coli sepsis at Yale-New Haven Hospital from 1979 to 2006 was performed. Study periods were based on predominant intrapartum antibiotic prophylaxis practices at Yale-New Haven Hospital, that is, (1) 1979 to 1992 (no formal intrapartum antibiotic prophylaxis), (2) 1993 to 1996 (risk factor-based), and (3) 1997 to 2006 (screening-based). Sepsis rates and patterns of ampicillin resistance were compared. RESULTS: Fifty-three cases of E. coli early-onset sepsis and 129 cases of E. coli late-onset sepsis were identified over 3 eras. In very low birth weight (<1500 g) infants, increases in E. coli early-onset sepsis (period 1: 2.83 cases per 1000 very low birth weight admissions; period 2: 7.12 cases per 1000 very low birth weight admissions; period 3: 10.22 cases per 1000 very low birth weight admissions), intrapartum ampicillin exposure, and ampicillin-resistant E. coli were observed. Intrapartum ampicillin exposure was determined to be an independent risk factor for ampicillin-resistant E. coli early-onset sepsis. For the first time, a significant increase in E. coli late-onset sepsis was observed in preterm infants (period 1: 10.39 cases per 1000 very low birth weight admissions; period 2: 16.01 cases per 1000 very low birth weight admissions; period 3: 21.66 cases per 1000 very low birth weight admissions) and term infants (period 1: 4.07 cases per 1000 admissions; period 2: 4.22 cases per 1000 admissions; period 3: 8.23 cases per 1000 admissions). CONCLUSIONS: Studies to provide a better understanding of potential consequences of intrapartum antibiotic exposure and its contribution to evolving trends in neonatal sepsis are urgently needed.

Published 2 April 2008 in Pediatrics, 121(4): 689-96.
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