European Journal of Pediatrics

, Volume 176, Issue 9, pp 1227–1234 | Cite as

Escherichia coli early-onset sepsis: trends over two decades

  • Natalia Mendoza-Palomar
  • Milena Balasch-Carulla
  • Sabina González-Di Lauro
  • Maria Concepció CéspedesEmail author
  • Antònia Andreu
  • Marie Antoinette Frick
  • Maria Ángeles Linde
  • Pere Soler-Palacin
Original Article


Escherichia coli early-onset sepsis (EOS) is an important cause of mortality and morbidity in neonates, especially in preterm and very low birth weight (VLBW) newborns. The aim of our study was to evaluate potential changes in the clinical and microbiological characteristics of E. coli EOS in our setting. Epidemiological, clinical, and microbiological data from all neonates with proven E. coli EOS from January 1994 to December 2014 were retrospectively collected in a single tertiary care hospital in Barcelona (Spain). Seventy-eight E. coli EOS cases were analyzed. A slight increase in the incidence of E. coli EOS was observed during the study period. VLBW newborns remained the group with higher incidence (10.4 cases per 1000 live births) and mortality (35.3%). Systematic use of PCR increased E. coli EOS diagnosis, mainly in the term newborn group. There was an increase in resistant E. coli strains causing EOS, with especially high resistance to ampicillin and gentamicin (92.8 and 28.6%, respectively). Nonetheless, resistant strains were not associated with poorer clinical outcomes.

Conclusions: There is an urgent need to reconsider the empirical therapy used in neonatal EOS, particularly in VLBW newborns.

What is Known:

E. coli early-onset sepsis (EOS) and E. coli resistant strains have been described as overall stable but increasing in VLBW neonates (< 1.500 g) in previous studies.

What is New:

• Our study shows an increasing incidence of E. coli EOS in all age groups, overruling group B Streptoccocus for the last 10 years. E. coli resistant strains also increased equally in all age groups, with high resistance rates to our first line antibiotics (ampicillin and gentamicin).

• Empiric antibiotic therapy of EOS, mainly in VLBW newborns, should be adapted to this new scenario.


Newborn Early-onset neonatal infection Escherichia coli Antimicrobial drug resistance 



Central nervous system


Cerebroespinal fluid

E. coli

Escherichia coli


Early-onset sepsis


Extended-spectrum beta-lactamase


Group B Streptoccocus


Neonatal intensive care unit


Polymerase chain reaction


Very low birth weight



We thank Santiago Pérez-Hoyos, Jose Ángel Rodrigo and Paula Peremiquel for the statistical analysis and Celine Cavallo for English language support.

Authors’ contributions

AA, AL, MCC and PS conceived and designed the study. MB, NM and SG collected data from electronical and written records. MAF, MCC and NM analyzed and interpreted data. MAF, MB, NM and SG draft the manuscript. AA, AL, MCC and PS reviewed critically the manuscript. All the authors gave final approval of the version to be submitted and any reviewed version.

Compliance with ethical standards

The Ethics Committee of HUVH approved the study in May, 2015 (PR(AMI)158/2015). None of the authors received funding for this study. Exemption of informed consent was conceded due to the retrospective character of the study. Patients were codified and no personal information was recorded.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Natalia Mendoza-Palomar
    • 1
  • Milena Balasch-Carulla
    • 1
  • Sabina González-Di Lauro
    • 2
  • Maria Concepció Céspedes
    • 3
    Email author
  • Antònia Andreu
    • 2
  • Marie Antoinette Frick
    • 1
  • Maria Ángeles Linde
    • 3
  • Pere Soler-Palacin
    • 1
  1. 1.Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de BarcelonaInstitut de Recerca Vall d’HebronBarcelonaSpain
  2. 2.Department of Microbiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de BarcelonaInstitut de Recerca Vall d’HebronBarcelonaSpain
  3. 3.Neonatal Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Autònoma de BarcelonaInstitut de Recerca Vall d’HebronBarcelonaSpain

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