title: The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008.
abstract: BACKGROUND
  Sepsis in the first 3 days of life is a leading cause of morbidity and mortality among infants. Group B Streptococcus (GBS), historically the primary cause of early-onset sepsis (EOS), has declined through widespread use of intrapartum chemoprophylaxis. We estimated the national burden of invasive EOS cases and deaths in the era of GBS prevention.
  
  
  METHODS
  Population-based surveillance for invasive EOS was conducted in 4 of the Centers for Disease Control and Prevention's Active Bacterial Core surveillance sites from 2005 to 2008. We calculated incidence using state and national live birth files. Estimates of the national number of cases and deaths were calculated, standardizing by race and gestational age.
  
  
  RESULTS
  Active Bacterial Core surveillance identified 658 cases of EOS; 72 (10.9%) were fatal. Overall incidence remained stable during the 3 years (2005: 0.77 cases/1000 live births; 2008: 0.76 cases/1000 live births). GBS (∼ 38%) was the most commonly reported pathogen followed by Escherichia coli (∼ 24%). Black preterm infants had the highest incidence (5.14 cases/1000 live births) and case fatality (24.4%). Nonblack term infants had the lowest incidence (0.40 cases/1000 live births) and case fatality (1.6%). The estimated national annual burden of EOS was approximately 3320 cases (95% confidence interval [CI]: 3060-3580), including 390 deaths (95% CI: 300-490). Among preterm infants, 1570 cases (95% CI: 1400-1770; 47.3% of the overall) and 360 deaths (95% CI: 280-460; 92.3% of the overall) occurred annually.
  
  
  CONCLUSIONS
  The burden of invasive EOS remains substantial in the era of GBS prevention and disproportionately affects preterm and black infants. Identification of strategies to prevent preterm births is needed to reduce the neonatal sepsis burden.
authors.affiliation: Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. csi7@cdc.gov
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Weston
authors.forename: Tracy
authors.initials: T
authors.lastname: Pondo
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Lewis
authors.forename: Pat
authors.initials: P
authors.lastname: Martell-Cleary
authors.forename: Craig
authors.initials: C
authors.lastname: Morin
authors.forename: Brenda
authors.initials: B
authors.lastname: Jewell
authors.forename: Pam
authors.initials: P
authors.lastname: Daily
authors.forename: Mirasol
authors.initials: M
authors.lastname: Apostol
authors.forename: Sue
authors.initials: S
authors.lastname: Petit
authors.forename: Monica
authors.initials: M
authors.lastname: Farley
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Art
authors.initials: A
authors.lastname: Reingold
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Andi L
authors.initials: AL
authors.lastname: Shane
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Zell
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Schrag
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D044383:Black People / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000208:ethnology / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000208:ethnology / Q000382:microbiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018805:Sepsis; D013290:Streptococcal Infections / Q000188:drug therapy / Q000208:ethnology / Q000382:microbiology / Q000401:mortality* / Q000517:prevention & control; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001741:Black or African American
chemical_list: D000900:Anti-Bacterial Agents