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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

Abstract

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.

Keywords

Newborn Early-onset neonatal infection Escherichia coli Antimicrobial drug resistance 

Abbreviations

CNS

Central nervous system

CSF

Cerebroespinal fluid

E. coli

Escherichia coli

EOS

Early-onset sepsis

ESBL

Extended-spectrum beta-lactamase

GBS

Group B Streptoccocus

NICU

Neonatal intensive care unit

PCR

Polymerase chain reaction

VLBW

Very low birth weight

Notes

Acknowledgements

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.

References

  1. 1.
    Alarcon A, Pena P, Salas S, Sancha M, Omeñaca F (2004) Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis. Pediatr Infect Dis J 23(4):295–299CrossRefPubMedGoogle Scholar
  2. 2.
    Allocati N, Masulli M, Alexeyev MF, Di Ilio C (2013) Escherichia coli in Europe: an overview. Int J Environ Res Public Health 10(12):6235–6254CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Andreu A, Ortega E, Planes AM, Salcedo S (2001) Evolution of perinatal Escherichia coli disease in the era of group B Streptococcus prophylaxis. Med Clin (Barc) 117(14):521–524CrossRefGoogle Scholar
  4. 4.
    Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG (2008) Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 121(4):689–696CrossRefPubMedGoogle Scholar
  5. 5.
    Bryan CS, John JF Jr, Pai MS, Austin TL (1985) Gentamicin vs cefotaxime for therapy for early neonatal sepsis. Relationship to drug resistance. Am J Dis Child 139:1086–1089CrossRefPubMedGoogle Scholar
  6. 6.
    Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L (2004) Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clin Chem 50(2):279–287CrossRefPubMedGoogle Scholar
  7. 7.
    Cordero L, Rau R, Taylor D, Ayer LW (2004 Jun) Enteric gram-negative bacilli bloodstream infections: 17 years’ experience in a neonatal intensive care unit. Am J Infect Control 32(4):189–195CrossRefPubMedGoogle Scholar
  8. 8.
    Dutta S, Narang A, Chakraborty A, Ray P (2009) Diagnosis of neonatal sepsis using universal primer polymerase chain reaction before and after starting antibiotic drug therapy. Arch Pediatr Adolesc Med 163(1):6–11CrossRefPubMedGoogle Scholar
  9. 9.
    Gagliotti C, Balode A, Baguero F, Degener J, Grundmann H, Gür D et al. Escherichia coli and Staphylococcus aureus: bad news and good news from the European Antimicrobial Resistance Surveillance Network (EARS-Net, formerly EARSS), 2002 to 2009. Euro Surveill. 2011;16(11)Google Scholar
  10. 10.
    Guiral E, Bosch J, Vila J, Soto SM (2011) Antimicrobial resistance of Escherichia coli strains causing neonatal sepsis between 1998 and 2008. Chemotherapy 58(2):123–128CrossRefGoogle Scholar
  11. 11.
    Hasvold J, Bradford L, Nelson C, Harrison C, Attar M, Stillwell T (2013) Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis. J Neonatal Perinatal Med 6(2):137–137Google Scholar
  12. 12.
    Heideking M, Lander F, Hufnagel M, Pfeifer Y, Wicker E, Krause G, Berner R (2013) Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009-2010. Eur J Clin Microbiol Infect Dis 32:1221–1223CrossRefPubMedGoogle Scholar
  13. 13.
    Hyde T, Hilger T, Reingold A, Farley MM, O’Brien KL, Schuchat A (2002) Trends in incidence and antimicrobial resistance of early-onset sepsis: population based surveillance in San Francisco and Atlanta. Pediatrics 110(4):690–695CrossRefPubMedGoogle Scholar
  14. 14.
    Jordan JA, Durso MB (2000) Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia. J Clin Microbiol 38(7):2574–2578PubMedPubMedCentralGoogle Scholar
  15. 15.
    Klein JO, Marcy SM (1995) Bacterial sepsis and meningitis. In: Remington JS, Klein JO (eds) Infectious diseases of the fetus and newborn infant, 4th edn. WB Saunders Co., Philadelphia, pp 835–890Google Scholar
  16. 16.
    Laforgia N, Coppola B, Carbone R, Grassi A, Mautone A, Iolascon A (1997) Rapid detection of neonatal sepsis using polymerase chain reaction. Acta Paediatr 86(10):1097–1099CrossRefPubMedGoogle Scholar
  17. 17.
    López JB, Coto GD, Fernández B (2005) Neonatal sepsis of vertical transmission: an epidemiological study from the “Grupo de Hospitales Castrillo”. J Perinat Med 28(4):309–315Google Scholar
  18. 18.
    López JB, Fernández B, Coto GD, Ramos A (2005) Grupo de Hospitales Castrillo. Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention. Acta Paediatr 94(4):451–457CrossRefGoogle Scholar
  19. 19.
    Maayan-Metzger A, Barzialai A, Keller N, Kuint J (2009) Are the ‘good old’ antibiotics still appropriate for early onset neonatal sepsis? A 10 year survey. Isr Med Assoc J 11:138–142PubMedGoogle Scholar
  20. 20.
    Mayor-Lynn K, González-Quintero VH, O'Sullivan MJ, Harststein AI, Roger S, Tamayo M (2005) Comparison of early-onset neonatal sepsis caused by Escherichia coli and group B Streptococcus. Am J Obstet Gynecol 192(5):1437–1439CrossRefPubMedGoogle Scholar
  21. 21.
    Neonatal infection: antibiotics for prevention and treatment. National Institute for Health and Clinical Excellence (NICE) guidelines [CG149]. Published date: August 2012. Last accessed June 2016Google Scholar
  22. 22.
    Pammi M, Flores A, Leeflang M, Versalovic J (2011) Molecular assays in the diagnosis of neonatal sepsis: a systematic review and meta-analysis. Pediatrics 128:973–985CrossRefGoogle Scholar
  23. 23.
    Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM, Ascher DP (1996) Volume of blood required to detect common neonatal pathogens. J Pediatr 129(2):275–278CrossRefPubMedGoogle Scholar
  24. 24.
    Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrisson LH, Lefkowitz LB, Hadler JL, Danila R, Cieslak PR, Schuchat A (2000) Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 342:15–20CrossRefPubMedGoogle Scholar
  25. 25.
    Stoll BJ, Hansen N, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs PK et al (2011) Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics 27(5):817–826CrossRefGoogle Scholar
  26. 26.
    Stoll BJ, Hansen N (2003) Infections in VLBW infants: studies from the NICHD neonatal research network. Semin Perinatol 27(4):293–301CrossRefPubMedGoogle Scholar
  27. 27.
    Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkraz RA, Lemons JA et al (2002) Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 347(4):240–247CrossRefPubMedGoogle Scholar
  28. 28.
    Tameliene R, Barcaite E, Stoniene D, Buinaskiene J, Markuniene E, Kudreviciene A, Vitkauskiene A, Jomantiene D, Nadisauskiene R (2012) Escherichia coli colonization in neonates: prevalence, perinatal transmission, antimicrobial susceptibility, and risk factors. Medicina (Kaunas) 48(2):71–76Google Scholar
  29. 29.
    Tsai C, Chen Y, Wang K, Chen C, Chen C (2012) Characteristics of early-onset neonatal sepsis caused by Escherichia coli. Taiwan J Obstet Gynecol 51(1):26–30CrossRefPubMedGoogle Scholar
  30. 30.
    Wang P (2013) A combination of ampicillin and aminoglycoside for early-onset neonatal sepsis. Editorial on Taiwan. J Obstet Gynecol 52:1–2Google Scholar
  31. 31.
    Weissman SJ, Hansen NI, Zaterka-Baxter K, Higgins RD, Stoll BJ (2015) Emergence of antibiotic resistance-associated clones among Escherichia coli recovered from newborns with early-onset sepsis and meningitis in the United States, 2008–2009. J Pediatric Infect Dis SocGoogle Scholar

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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