title: The changing face of early-onset neonatal sepsis after the implementation of a maternal group B Streptococcus screening and intrapartum prophylaxis policy--a study in one medical center.
abstract: BACKGROUND
  Early-onset sepsis (EOS) is the major cause of neonatal morbidity and mortality. Maternal group B Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP) were implemented in our hospital in 2004. Our aim was to evaluate the effectiveness of the program and changes in pathogens and antibiotic susceptibility.
  
  
  METHODS
  The medical charts of mothers and infants with EOS between January 2001 and November 2008 were retrospectively reviewed. EOS was defined as sepsis occurring within 72 hours of birth. Data were pooled and compared for January 2001 through September 2004 (Period 1, without GBS screening) and October 2004 through November 2008 (Period 2, with GBS screening and IAP).
  
  
  RESULTS
  The GBS screening rate increased from 10.11% in 2004 to 65% in 2008 and the IAP rate increased from 40% in 2004 to 90% in 2008. The most common EOS pathogen in Period 1 was GBS (45.4%), which decreased to 20% in Period 2 (p=0.081; trend p=0.009). The percentage of EOS because of Escherichia coli in Period 1 was 40.9% but increased to 70% in Period 2 (p=0.059). E coli EOS increased in extremely low birth weight premature babies weighing 500-1000g from Period 1 to Period 2 (p=0.031). The incidence of ampicillin-resistant E coli EOS was relatively high, but no significant change (88.9% vs. 92.9%) after implementation of GBS screening and IAP was noted.
  
  
  CONCLUSIONS
  GBS screening plus IAP is effective in decreasing the incidence of GBS EOS; however, an increase in EOS caused by E coli was noted. Monitoring of pathogens causing EOS is important for effective treatment.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Lin
authors.forename: Chyong-Hsin
authors.initials: CH
authors.lastname: Hsu
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
authors.forename: Jui-Hsing
authors.initials: JH
authors.lastname: Chang
authors.forename: Han-Yang
authors.initials: HY
authors.lastname: Hung
authors.forename: Hsin-An
authors.initials: HA
authors.lastname: Kao
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Peng
authors.forename: Wai-Tim
authors.initials: WT
authors.lastname: Jim
authors.forename: Hsin
authors.initials: H
authors.lastname: Chi
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
authors.forename: Tung-Yao
authors.initials: TY
authors.lastname: Chang
authors.forename: Chen-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Chie-Pein
authors.initials: CP
authors.lastname: Chen
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008403:Mass Screening / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013292:Streptococcus agalactiae; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin