Escherichia coli early-onset sepsis: trends over two decades
- 743 Downloads
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.
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.
KeywordsNewborn Early-onset neonatal infection Escherichia coli Antimicrobial drug resistance
Central nervous system
- E. coli
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.
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.
- 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
- 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.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
- 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
- 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
- 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
- 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
- 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.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