No change in the incidence of ampicillin-resistant, neonatal, early-onset sepsis over 18 years.
OBJECTIVE
The objective of this study was to assess the effect of maternal antibiotic exposure on neonatal early-onset sepsis (EOS) rates over an 18-year period.


METHODS
A review was performed of infant and maternal records for all culture- proven cases of EOS in infants delivered at the Brigham and Women's Hospital (Boston, MA) in 1990-2007.


RESULTS
Data were analyzed from 335 EOS cases over periods that differed with respect to hospital policy for intrapartum antibiotic prophylaxis against group B Streptococcus (GBS): 1990-1992 (no prophylaxis); 1993-1996 (risk-based); and 1997-2007 (screening-based). The overall incidence of EOS decreased over these periods (3.70 vs 2.23 vs 1.59 cases per 1000 live births; P < .0001). No change in the incidence of infection with ampicillin-resistant organisms was observed overall or among very low birth weight infants. However, an increased proportion of infections were caused by ampicillin- resistant organisms. Mothers of infants with ampicillin-resistant infections were more likely to have been treated with ampicillin (P = .0001). Overall peripartum antibiotic use increased during the study period primarily because of increased use of penicillin G and clindamycin, with no significant change in the use of ampicillin.


CONCLUSIONS
Predominant use of penicillin G for GBS prophylaxis resulted in decreased incidence of EOS. No change in the incidence of ampicillin-resistant EOS was observed, but resistant cases were associated with peripartum ampicillin exposure. These findings suggest that obstetricians should consider preferential use of penicillin G for GBS prophylaxis.
Puopolo
Karen M
KM
Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA. kpuopolo@partners.org
Eichenwald
Eric C
EC
D000668:Ampicillin Resistance; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D019102:Infant, Very Low Birth Weight; D008297:Male; D008826:Microbial Sensitivity Tests; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D013292:Streptococcus agalactiae