The impact of group B streptococcus prophylaxis on late-onset neonatal infections.
OBJECTIVE
To determine trends in late-onset neonatal infections and risk factors for ampicillin/penicillin-resistant microorganisms.


METHODS
Data on 584 infants with positive blood, urine or cerebrospinal fluid cultures for bacteria or fungi at 8-30 days of age from 1990 to 2007 were examined and divided into three epochs, based on intrapartum antibiotic prophylactic (IAP) practices. Pathogens and antibiotic resistance were compared among epochs.


RESULTS
The number of candidal infections increased over time for the entire population (P=0.006). There was an increased incidence of Gram-negative (P=0.009) and candidal infections (P=0.014) among very low-birthweight infants. Only Escherichia coli infections showed increasing ampicillin resistance over epochs (P=0.006). In regression analysis, ampicillin/penicillin resistance increased with IAP use (odds ratio 2.05).


CONCLUSIONS
Changing microorganisms and increasing antibiotic resistance in late-onset neonatal infections are likely multifactorial but are increased with IAP use, which may identify an at-risk population. Increasing Candida infections require further investigation.
Division of Neonatology, Crozer Chester Medical Center, Upland, PA, USA. kelly.ecker@crozer.org
K L
KL
Ecker
P K
PK
Donohue
K S
KS
Kim
J A
JA
Shepard
S W
SW
Aucott
D000328:Adult; D017668:Age of Onset; D000668:Ampicillin Resistance; D019072:Antibiotic Prophylaxis; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004927:Escherichia coli Infections / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D013292:Streptococcus agalactiae