PEDIATRICS Vol. 105 No. 1 January 2000, pp. 21-26
Received Apr 20, 1999; accepted Jun 8, 1999.
,
,
,
From the * Centers for Disease Control and Prevention, Atlanta,
Georgia;
Medical College of Virginia of Virginia Commonwealth
University, Richmond, Virginia; § University of Tennessee at Memphis,
Regional Medical Center, Memphis, Tennessee;
University of Puerto
Rico, San Juan, Puerto Rico; ¶ University of Miami Medical
Center-Jackson Memorial Hospital, Miami, Florida; # University of
Mississippi Medical Center, Jackson, Mississippi; ** Broward General
Medical Center, Fort Lauderdale, Florida; and the 
Department of
Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear.
Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis.
Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) and
Escherichia coli (0.6 cases per 1000 births) caused most
infections. GBS sepsis less often occurred in preterm deliveries
compared with other sepsis. Compared with gestation-matched
controls without documented sepsis, GBS disease was associated with
intrapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal
exams (matched OR, 2.9; CI, 1.1-8.0). An obstetric risk
factor
preterm delivery, intrapartum fever, or membrane rupture
18
hours
was found in 49% of GBS cases and 79% of other sepsis. IAP had
an adjusted efficacy of 68.2% against any early-onset sepsis.
Ampicillin resistance was evident in 69% of E coli
infections. No deaths occurred among susceptible E coli
infections, whereas 41% of ampicillin-resistant E coli
infections were fatal. Ninety-one percent of infants who developed
ampicillin-resistant E coli infections were preterm, and
59% of these infants were born to mothers who had received IAP.
Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin-resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis. Key words: group B streptococcal, neonatal, sepsis, meningitis, Escherichia coli, antibiotic resistance, streptococcal, risk factors.
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