title: Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.
abstract: 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, USA. barbara_stoll@oz.ped.emory.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Roger G
authors.initials: RG
authors.lastname: Faix
authors.forename: Brenda B
authors.initials: BB
authors.lastname: Poindexter
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bizzarro
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Frantz
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kennedy
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Watterberg
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Kurt
authors.initials: K
authors.lastname: Schibler
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Andi L
authors.initials: AL
authors.lastname: Shane
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Schrag
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D015997:Neonatal Screening / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D016019:Survival Analysis; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents