title: Correlation of bacterial type and antibiotic sensitivity with maternal antibiotic exposure in early-onset neonatal sepsis.
abstract: BACKGROUND
  Antibiotic administration during pregnancy as group B Streptococcus prophylaxis or as treatment of maternal conditions has become widespread.
  
  
  OBJECTIVE
  To assess whether bacterial type and antibiotic resistance in early-onset neonatal sepsis are associated with maternal antibiotic use.
  
  
  METHODS
  All positive blood and/or cerebrospinal fluid cultures (case-only study) and respective antibiotic sensitivities from newborns delivered in Shaare Zedek Medical Center, Jerusalem, Israel, between 01/01/1997 and 31/01/2007, taken during the first 72 h of life, were studied. Clinical and demographic data were obtained from the medical records of the infant/mother dyads. Three groups were defined by type of maternal antibiotic exposure: (1) no exposure, (2) intrapartum antibiotic prophylaxis (IAP), (3) antepartum antibiotic exposure during the month prior to delivery and extending into delivery or with subsequent IAP (AAE). Factors potentially associated with Gram-negative bacteremia and resistance to ampicillin were analyzed using multivariate logistic regression.
  
  
  RESULTS
  Ninety-seven different organisms grew from 94 infants (1.03 per 1,000 live births). By univariate analysis, AAE, gestational age ≤ 32 weeks, chorioamnionitis and rupture of membranes ≥ 18 h, were significantly associated with both Gram-negative sepsis and antibiotic resistance. By multivariate analysis, AAE was significantly associated with both outcomes, while gestational age ≤32 weeks was only associated with antibiotic resistance.
  
  
  CONCLUSIONS
  AAE for more than 24 h is associated with an increased proportion of Gram-negative organisms and ampicillin resistance in early-onset neonatal sepsis. Antepartum antibiotic therapy and its ramifications need to be continuously monitored and prospectively studied.
authors.affiliation: Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel. bromi @ szmc.org.il
authors.forename: Ruben
authors.initials: R
authors.lastname: Bromiker
authors.forename: Netanela
authors.initials: N
authors.lastname: Ernest
authors.forename: Maskit Bar
authors.initials: MB
authors.lastname: Meir
authors.forename: Michael
authors.initials: M
authors.lastname: Kaplan
authors.forename: Cathy
authors.initials: C
authors.lastname: Hammerman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Schimmel
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Schlesinger
mesh_terms: D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification*; D001424:Bacterial Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000151:congenital / Q000453:epidemiology; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D018811:Maternal Exposure / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000134:cerebrospinal fluid / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000151:congenital* / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents