Ten-year study on the effect of intrapartum antibiotic prophylaxis on early onset group B streptococcal and Escherichia coli neonatal sepsis in Australasia.
BACKGROUND
Intrapartum antibiotics have reduced the incidence of neonatal early onset (EO) group B streptococcal (GBS) disease. Some surveillance data suggest that this success may be at the cost of increasing rates of non-GBS infection, especially in premature neonates.


OBJECTIVE
To examine rates of EOGBS infection and EO Escherichia coli neonatal sepsis in Australasia.


METHODS
Analysis of trends in EO (<48 h age) GBS and E. coli sepsis from longitudinal prospective surveillance data collected from representative tertiary obstetric hospitals in each state of Australia and selected centers in New Zealand during a 10-year period from 1992 through 2001. Statistical analysis used Poisson regression.


RESULTS
206 GBS and 96 E. coli cases occurred in 298,319 live births during the study period. The EOGBS sepsis rate fell from a peak of 1.43/1000 live births in 1993 to 0.25/1000 in 2001 (P < 0.001). The overall EO E. coli sepsis rate was 0.32/1000. In babies with birth weight <1500 g, it was 6.20/1000. There was an overall trend to decreasing EO E. coli sepsis (P = 0.07), and there was no significant change in E. coli sepsis in babies <1500 g (P = 0.60). Sixty-nine percent of E. coli cases occurred in the <1500 g cohort; the case fatality rate in this group was 50%. The overall case fatality rate from E. coli sepsis was 36%, and this rate remained stable during the study period (P = 0.47).


CONCLUSIONS
The increasing use of intrapartum antibiotics produced a steady decline in EOGBS disease in Australasia. There was also a trend to decreasing EO E. coli sepsis in all babies, and the rate in very low birth weight infants remained stable.
Daley
Andrew J
AJ
Department of Microbiology and Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia. andrew.daley@wch.org.au
Isaacs
David
D
D019072:Antibiotic Prophylaxis; D001315:Australia / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D016012:Poisson Distribution; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D013292:Streptococcus agalactiae