Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues

被引：812

作者：

Stoll, Barbara J. ^{[1
,2
]}

Hansen, Nellie I. ^{[3
]}

Sanchez, Pablo J. ^{[4
]}

Faix, Roger G. ^{[5
]}

Poindexter, Brenda B. ^{[6
]}

Van Meurs, Krisa P. ^{[7
]}

Bizzarro, Matthew J. ^{[8
]}

Goldberg, Ronald N. ^{[9
]}

Frantz, Ivan D., III ^{[10
]}

Hale, Ellen C. ^{[1
,2
]}

Shankaran, Seetha ^{[11
]}

Kennedy, Kathleen ^{[12
]}

Carlo, Waldemar A. ^{[13
]}

Watterberg, Kristi L. ^{[14
]}

Bell, Edward F. ^{[15
]}

Walsh, Michele C. ^{[16
]}

Schibler, Kurt ^{[17
]}

Laptook, Abbot R. ^{[18
]}

Shane, Andi L. ^{[1
,2
]}

Schrag, Stephanie J. ^{[19
]}

Das, Abhik ^{[20
]}

Higgins, Rosemary D. ^{[21
]}

机构：

[1] Emory Univ, Sch Med, Dept Pediat, Atlanta, GA 30322 USA

[2] Childrens Healthcare Atlanta, Atlanta, GA USA

[3] RTI Int, Stat & Epidemiol Unit, Res Triangle Pk, NC USA

[4] Univ Texas SW Med Ctr Dallas, Dept Pediat, Dallas, TX 75390 USA

[5] Univ Utah, Sch Med, Dept Pediat, Div Neonatol, Salt Lake City, UT USA

[6] Indiana Univ Sch Med, Dept Pediat, Indianapolis, IN USA

[7] Stanford Univ, Med Ctr, Div Neonatol, Palo Alto, CA 94304 USA

[8] Yale Univ, Sch Med, Dept Pediat, New Haven, CT 06510 USA

[9] Duke Univ, Dept Pediat, Durham, NC 27706 USA

[10] Floating Hosp Children, Tufts Med Ctr, Dept Pediat, Boston, MA USA

[11] Wayne State Univ, Dept Pediat, Detroit, MI 48202 USA

[12] Univ Texas Med Sch Houston, Dept Pediat, Houston, TX USA

[13] Univ Alabama Birmingham, Div Neonatol, Birmingham, AL USA

[14] Univ New Mexico, Dept Pediat, Hlth Sci Ctr, Albuquerque, NM 87131 USA

[15] Univ Iowa, Dept Pediat, Iowa City, IA 52242 USA

[16] Case Western Reserve Univ, Rainbow Babies & Childrens Hosp, Dept Pediat, Cleveland, OH 44106 USA

[17] Univ Cincinnati, Dept Pediat, Cincinnati, OH 45221 USA

[18] Brown Univ, Women & Infants Hosp, Dept Pediat, Providence, RI 02908 USA

[19] Ctr Dis Control & Prevent, Atlanta, GA USA

[20] RTI Int, Stat & Epidemiol Unit, Rockville, MD USA

[21] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Bethesda, MD USA

来源：

PEDIATRICS | 2011年 / 127卷 / 05期

基金：

美国国家卫生研究院;

关键词：

neonatal sepsis; group B streptococcal disease; Escherichia coli infection; ESCHERICHIA-COLI; INFECTIONS; ERA; MENINGITIS; PATTERNS;

D O I：

10.1542/peds.2010-2217

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was defined by positive culture results for blood and cerebrospinal fluid obtained from infants aged <= 72 hours plus treatment with antibiotic therapy for >= 5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006-2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge. Pediatrics 2011;127:817-826

引用

页码：817 / 826

页数：10

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