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Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics

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Abstract

Widespread use of intrapartum antimicrobial prophylaxis has significantly reduced the incidence of early-onset neonatal infection (EONI); however, little is known about the effects of increased maternal exposure to antibiotics on late-onset neonatal infection (LONI). This study aims to evaluate LONI epidemiology in our region after the application of French recommendations and to determine whether LONI-causing organisms and their antibiotic susceptibility are influenced by peripartum antibiotic exposure. We performed a prospective epidemiologic study of 139 confirmed and possible cases of bacterial LONI in patients treated with antibiotics for at least 5 days of the 22,458 infants born in our region in the year 2007. The overall incidence of LONI caused by all pathogens, Group B streptococcus (GBS) and Escherichia coli (E. coli) were 6.19, 0.36 and 2.72, respectively, per 1,000 live births. Our findings revealed three major types of LONI: E. coli-induced urinary tract infection (UTI) among term infants, coagulase negative Staphylococcus septicemia affecting preterm infants, and GBS infections with severe clinical presentation. Univariable analysis revealed that maternal antibiotic exposure was significantly associated with the risk of amoxicillin-resistant E. coli infection (p = 0.01). Postnatal antibiotic exposure was associated with an increased risk of E. coli LONI (p = 0.048). This link persisted upon multivariable analysis; however, no additional risk factors were identified for LONI caused by antibiotic-resistant E. coli. Conclusion Our findings confirm that despite the benefits of antenatal antibiotics, this treatment can increase the risk of antibiotic-resistant cases of LONI. National and international surveillance of LONI epidemiology is essential to assess benefits and potential negative consequences of perinatal antibiotic exposure.

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Acknowledgements

The following investigators also participated in this trial. All investigators are members of the Eastern Neonatology Study Group and/or the regional perinatal network, “Naître en Alsace”: Centre Hospitalier de Haguenau—André Geraudel, Centre Hospitalier de Colmar—Michel Kretz, Centre Hospitalier de Mulhouse—Marc Benoît, Centre Hospitalier de Saverne—Houria Demil, Clinique Adassa Strasbourg—Ziad Mansour, Clinique Sainte Anne Strasbourg—Mohamed Jernite, Centre Hospitalier de Wissembourg—Izzat Mikaïl, and Centre Médico-Chirurgical et Obstétrical de Schiltigheim—Michèle Weil. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Service de Pédiatrie 2, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France

    Capucine Didier, Jean Messer, Lionel Donato, Dominique Astruc & Pierre Kuhn

  2. Service de Pédiatrie, Centre Hospitalier de Haguenau, Haguenau, France

    Marie-Pierre Streicher

  3. Service de Pédiatrie, Hôpital le Parc, Centre Hospitalier de Colmar, Colmar, France

    Didier Chognot

  4. Service de Pédiatrie, Centre hospitalier de Mulhouse, Mulhouse, France

    Raphaèle Campagni

  5. Service de Pédiatrie, Centre Hospitalier de Saverne, Saverne, France

    Albert Schnebelen

  6. Service de Gynécologie et Obstétrique, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France

    Bruno Langer

  7. Service de Biostatistique et Méthodologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France

    Nicolas Meyer

  8. Médecine et Réanimation néonatale, Service de Pédiatrie 2, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Avenue Molière, 67098, Strasbourg, France

    Pierre Kuhn

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  1. Capucine Didier
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Correspondence to Pierre Kuhn.

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Didier, C., Streicher, MP., Chognot, D. et al. Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics. Eur J Pediatr 171, 681–687 (2012). https://doi.org/10.1007/s00431-011-1639-7

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  • DOI: https://doi.org/10.1007/s00431-011-1639-7

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