title: The burden of early-onset sepsis in Emilia-Romagna (Italy): a 4-year, population-based study.
abstract: To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS.
  
  
  
  Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed.
  
  
  
  Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight <1000 g (20.37/1000 LB and 8.49/1000 LB, respectively). The most common pathogens were GBS (n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coli EOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%).
  
  
  
  GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate.
authors.affiliation: a Dipartimento Integrato Materno-Infantile , Azienda Ospedaliero-Universitaria Policlinico, Unità Operativa di Terapia Intensiva Neonatale , Modena , Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Berardi
authors.affiliation: b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy .
authors.forename: Lorenza
authors.initials: L
authors.lastname: Baroni
authors.affiliation: c Dipartimento Cardiovascolare , Azienda Ospedaliero-Universitaria S. Orsola-Malpighi , Bologna , Italy .
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.affiliation: d Unità Operativa di Microbiologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi , Bologna , Italy .
authors.forename: Simone
authors.initials: S
authors.lastname: Ambretti
authors.affiliation: e Unità Operativa di Pediatria, Ospedale G da Saliceto , Piacenza , Italy .
authors.forename: Giacomo
authors.initials: G
authors.lastname: Biasucci
authors.affiliation: f Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi , Rimini , Italy .
authors.forename: Serenella
authors.initials: S
authors.lastname: Bolognesi
authors.affiliation: g Unità Operativa di Neonatologia, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant'orsola - Malpighi , Bologna , Italy .
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Capretti
authors.affiliation: h Laboratorio di Microbiologia , Dipartimento Interaziendale di Diagnostica per Immagini e Medicina di Laboratorio, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy .
authors.forename: Edoardo
authors.initials: E
authors.lastname: Carretto
authors.affiliation: i Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile , Ospedale Maggiore , Bologna , Italy .
authors.forename: Matilde
authors.initials: M
authors.lastname: Ciccia
authors.affiliation: j Unità Operativa di Pediatria, Ospedale B Ramazzini , Carpi , Italy .
authors.forename: Valentina
authors.initials: V
authors.lastname: Fiorini
authors.affiliation: k Unità Operativa di Terapia Intensiva Neonatale, Ospedale S. Anna , Ferrara , Italy .
authors.forename: Cinzia
authors.initials: C
authors.lastname: Fortini
authors.affiliation: b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy .
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Gargano
authors.affiliation: l Unità Operativa di Microbiologia, Laboratorio Unico Ausl della Romagna, Pievesestina Cesena , Italy .
authors.forename: Maria Federica
authors.initials: MF
authors.lastname: Pedna
authors.affiliation: m Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini , Cesena , Italy , and.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzo
authors.affiliation: n Reparto di Malattie Batteriche, Respiratorie e Sistemiche, Dipartimento MIPI, Istituto Superiore di Sanità , Roma , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Creti
authors.affiliation: a Dipartimento Integrato Materno-Infantile , Azienda Ospedaliero-Universitaria Policlinico, Unità Operativa di Terapia Intensiva Neonatale , Modena , Italy .
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ferrari
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001724:Birth Weight; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007558:Italy / Q000453:epidemiology; D000071074:Neonatal Sepsis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013290:Streptococcal Infections / Q000188:drug therapy; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000667:Ampicillin
keywords: Early-onset sepsis; group B streptococcus; intrapartum chemoprophylaxis; meningitis; newborn infant