The widespread use of intrapartum antibiotic prophylaxis (IAP) to prevent group B streptococcus (GBS) early-onset sepsis (EOS) is changing the epidemiology of EOS. Italian prospective area-based surveillance data (from 1 January 2016 to 31 December 2020) were used, from which we identified 64 cases of culture-proven EOS (E. coli, n = 39; GBS, n = 25) among 159,898 live births (annual incidence rates of 0.24 and 0.16 per 1000, respectively). Approximately 10% of E. coli isolates were resistant to both gentamicin and ampicillin. Five neonates died; among them, four were born very pre-term (E. coli, n = 3; GBS, n = 1) and one was born full-term (E. coli, n = 1). After adjustment for gestational age, IAP-exposed neonates had ≥95% lower risk of death, as compared to IAP-unexposed neonates, both in the whole cohort (OR 0.04, 95% CI 0.00–0.70; p = 0.03) and in the E. coli EOS cohort (OR 0.05, 95% CI 0.00–0.88; p = 0.04). In multi-variable logistic regression analysis, IAP was inversely associated with severe disease (OR = 0.12, 95% CI 0.02–0.76; p = 0.03). E. coli is now the leading pathogen in neonatal EOS, and its incidence is close to that of GBS in full-term neonates. IAP reduces the risk of severe disease and death. Importantly, approximately 10% of E. coli isolates causing EOS were found to be resistant to typical first-line antibiotics.

Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis / Miselli, F.; Cuoghi Costantini, R.; Creti, R.; Sforza, F.; Fanaro, S.; Ciccia, M.; Piccinini, G.; Rizzo, V.; Pasini, L.; Biasucci, G.; Pagano, R.; Capretti, M.; China, M.; Gambini, L.; Pulvirenti, R. M.; Dondi, A.; Lanari, M.; Pedna, M.; Ambretti, S.; Lugli, L.; Bedetti, L.; Berardi, A.. - In: MICROORGANISMS. - ISSN 2076-2607. - 10:10(2022), pp. 1-13. [10.3390/microorganisms10101878]

Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis

Miselli F.;Cuoghi Costantini R.;Sforza F.;Piccinini G.;Rizzo V.;Biasucci G.;Pagano R.;China M.;Lugli L.;Bedetti L.;Berardi A.
2022

Abstract

The widespread use of intrapartum antibiotic prophylaxis (IAP) to prevent group B streptococcus (GBS) early-onset sepsis (EOS) is changing the epidemiology of EOS. Italian prospective area-based surveillance data (from 1 January 2016 to 31 December 2020) were used, from which we identified 64 cases of culture-proven EOS (E. coli, n = 39; GBS, n = 25) among 159,898 live births (annual incidence rates of 0.24 and 0.16 per 1000, respectively). Approximately 10% of E. coli isolates were resistant to both gentamicin and ampicillin. Five neonates died; among them, four were born very pre-term (E. coli, n = 3; GBS, n = 1) and one was born full-term (E. coli, n = 1). After adjustment for gestational age, IAP-exposed neonates had ≥95% lower risk of death, as compared to IAP-unexposed neonates, both in the whole cohort (OR 0.04, 95% CI 0.00–0.70; p = 0.03) and in the E. coli EOS cohort (OR 0.05, 95% CI 0.00–0.88; p = 0.04). In multi-variable logistic regression analysis, IAP was inversely associated with severe disease (OR = 0.12, 95% CI 0.02–0.76; p = 0.03). E. coli is now the leading pathogen in neonatal EOS, and its incidence is close to that of GBS in full-term neonates. IAP reduces the risk of severe disease and death. Importantly, approximately 10% of E. coli isolates causing EOS were found to be resistant to typical first-line antibiotics.
2022
10
10
1
13
Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis / Miselli, F.; Cuoghi Costantini, R.; Creti, R.; Sforza, F.; Fanaro, S.; Ciccia, M.; Piccinini, G.; Rizzo, V.; Pasini, L.; Biasucci, G.; Pagano, R.; Capretti, M.; China, M.; Gambini, L.; Pulvirenti, R. M.; Dondi, A.; Lanari, M.; Pedna, M.; Ambretti, S.; Lugli, L.; Bedetti, L.; Berardi, A.. - In: MICROORGANISMS. - ISSN 2076-2607. - 10:10(2022), pp. 1-13. [10.3390/microorganisms10101878]
Miselli, F.; Cuoghi Costantini, R.; Creti, R.; Sforza, F.; Fanaro, S.; Ciccia, M.; Piccinini, G.; Rizzo, V.; Pasini, L.; Biasucci, G.; Pagano, R.; Capretti, M.; China, M.; Gambini, L.; Pulvirenti, R. M.; Dondi, A.; Lanari, M.; Pedna, M.; Ambretti, S.; Lugli, L.; Bedetti, L.; Berardi, A.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1301174
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