Late and very late onset group B Streptococcus sepsis: one and the same?
BACKGROUND
This study aimed to describe the clinical characteristics of group B Streptococcus (GBS) sepsis in infants aged 4-90 days [late onset (LO)] compared to infants >90 days of age [very late onset (VLO)].


METHODS
Microbiology records at Children's Medical Center Dallas were screened. Demographic, clinical, and outcome data were collected for infants with GBS recovered from blood or cerebrospinal fluid culture from January 1, 2006 to July 1, 2012.


RESULTS
Totally 48 infants were identified (42 LO, 6 VLO). Infants with VLO sepsis had lower median gestational age (28.5 vs. 39 weeks gestation, P<0.001) and longer median nursery admissions (8.8 vs. 0.5 weeks, P=0.004). When gestational age was controlled for, there were no differences in clinical presentation, intensive care unit admission, length of stay, neurodevelopmental outcome, and mortality. Infants with VLO sepsis were more likely to receive vancomycin (83% vs. 33%, P=0.02) or third-generation cephalosporins (83% vs. 24%, P=0.009), and more likely to continue on those agents even after GBS was identified.


CONCLUSIONS
Infants with VLO sepsis had lower gestational ages and longer nursery stays than infants with LO sepsis. Beyond age at presentation, there were no significant differences in clinical presentations, hospital course, frequency of neurodevelopmental sequelae, and mortality in infants presenting with LO vs. VLO GBS sepsis. Infants with VLO sepsis were more likely to receive empiric broad spectrum antimicrobials and more likely to continue receiving broad therapy even following GBS identification.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA, joseph.cantey@utsouthwestern.edu.
Joseph B
JB
Cantey
Courtney
C
Baldridge
Rachel
R
Jamison
Leticia A
LA
Shanley
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D013292:Streptococcus agalactiae; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents