Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008

Abstract

Objective:

Organisms causing early-onset neonatal sepsis (EONS) have consistently changed over time. The distribution of organisms in EONS helps to influence the appropriate type of antibiotic prophylaxis strategy during labor and the antibiotics used in neonates with suspected sepsis.

Study Design:

To compare the organisms distribution for EONS between 2003 and 2008 for infants admitted to neonatal intensive care units (NICUs) in Canada. Data were retrieved from infants with a positive bacterial blood or cerebrospinal fluid culture in the first 72 h after birth who were admitted to NICUs participating in the Canadian Neonatal Network from 2003 to 2008. Comparisons of incidence rate, demographics and causative organisms were carried out between earlier cohort (2003 to 2005) and later cohort (2006 to 2008).

Result:

A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n=24969) in the earlier cohort compared with 6.2/1000 admissions (n=37484) in the later cohort (P=0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P=0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms.

Conclusion:

Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Maayan-Metzger A, Barzilai A, Keller N, Kuint J . Are the ‘good old’ antibiotics still appropriate for early-onset neonatal sepsis? A 10 year survey. Israel Med Assoc J 2009; 11 (3): 138–141.

    Google Scholar 

  2. Stroll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Change in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347 (4): 240–247.

    Article  Google Scholar 

  3. Edwards RK, Jamie WE, Sterner D, Gentry S, Counts K, Duff P . Intrapartum antibiotic prophylaxis and early-onset neonatal sepsis patterns. Infect Dis Obstet Gynecol 2003; 11 (4): 221–226.

    Article  Google Scholar 

  4. Baltimore RS, Huie SM, Meek JI, Schuchat A, O’Brien KL . Early-onset neonatal sepsis in the era of group B streptococcal prevention. Pediatrics 2001; 108 (5): 1094–1098.

    Article  CAS  Google Scholar 

  5. Barrington KJ . Management of the Infant at Increased Risk for Sepsis. Position Statement. Canadian Paediatric Society: Ottawa, 2007.

    Google Scholar 

  6. Aziz K, McMillan DD, Andrews D, Pendray M, Qiu Z, Karuri S et al. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr 2005; 5: 22.

    Article  Google Scholar 

  7. Gerdes JS . Diagnosis and management of bacterial infections in the neonate. Pediatr Clin N Am 2004; 51 (4): 939–959.

    Article  Google Scholar 

  8. Bizzarro MJ, Raskin C, Baltimore RS, Gallagher PG . Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005; 116 (3): 595–602.

    Article  Google Scholar 

  9. Centers for Disease Control and Prevention. Trends in Perinatal Group B Streptococcal Disease. Weekly Report. US Department of Health and Human Services: Atlanta, 2009.

  10. Alarcon A, Peña P, Salas S, Sancha M, Omeñaca F . Neonatal early onset escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis. Pediatr Infect Dis J 2004; 23 (4): 295–299.

    Article  Google Scholar 

  11. Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG . Changing patterns in neonatal escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 2008; 121 (4): 689–696.

    Article  Google Scholar 

  12. Canadian NICU network Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R et al. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics 2000; 106 (5): 1070–1079.

    Article  Google Scholar 

  13. Klinger G, Levy I, Sirota L, Boyko V, Lerner-Geva L, Reichman B . Outcome of early-onset sepsis in a national cohort of very low birth weight infants. Pediatrics 2010; 125 (4): 736–740.

    Article  Google Scholar 

  14. Anderson-Berry A, Brinton B, Lyden E, Faix RG . Risk factors associated with development of persistent coagulase-negative staphylococci bacteremia in the neonate and associated short-term and discharge morbidities. Neonatology 2011; 99 (1): 23–31.

    Article  Google Scholar 

  15. Puopolo KM, Eichenwald EC . No Change in the incidence of ampicillin-resistant, neonatal, early-onset sepsis over 18 years. Pediatrics 2010; 125: e1031–e1038.

    Article  Google Scholar 

  16. Kuhn P, Dheu C, Bolender C, Chognot D, Keller L, Demil H et al. Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics. Paediat Perinat Epidemiol 2010; 24 (5): 479–487.

    Article  Google Scholar 

  17. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S et al. Epidemiology of invasive Group B Streptococcal disease in the United States, 1999-2005. JAMA 2008; 299 (17): 2056–2065.

    Article  CAS  Google Scholar 

  18. Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P, Reingold A, Schuchat A . Risk factors for invasive, early-onset escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics 2006; 118 (2): 570–576.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by grant MOP-53115 from the Canadian Institutes of Health Research. Additional funding was provided by BC's Children's Hospital Foundation; Calgary Regional Health Authority; Dalhousie University Neonatal-Perinatal Medicine Research Fund; the Division of Neonatology, Children's Hospital of Eastern Ontario; the Child Health Program, Health Care Corporation of St John's; The Neonatology Program, Hospital for Sick Children; the Lawson Research Institute; Mount Sinai Hospital; Saint Boniface Hospital, Saint Joseph's Health Centre; the University of Saskatchewan Neonatal Research Fund; the University of Western Ontario; Victoria General Hospital; Winnipeg Health Sciences Centre; and the Women's College Hospital. We thank Woojin Yoon for statistical support of this project and Sarah De La Rue for editorial assistance with this manuscript, both of whom are part of the MiCare Research Centre, which is supported by the Ontario Ministry of Health and Long-Term Care. The Canadian Neonatal Network is also coordinated by the MiCare Research Center. Funding agencies had no role in the design, collection, analyses or interpretation of results of this study.

Author contributions

Michael Sgro initiated concept, developed draft, analyzed data and wrote the manuscript. Prakesh S Shah initiated concept, developed draft, analyzed data and made critical revisions to the manuscript. Doug Campbell participated in design, reviewed protocol and assisted with manuscript writing. Alycia Tenuta participated in the design and concept, and collected data. Sandesh Shivananda participated in review of results, analysis and revision of manuscript. Shoo K Lee participated in the design of the study, reviewed the results and assisted with manuscript preparation.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to M Sgro.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Appendix

Appendix

Site Investigators of the Canadian Neonatal Network

Shoo K Lee, (Director, Canadian Neonatal Network); Prakesh S Shah (Associate Director, Canadian Neonatal Network); Wayne Andrews (Janeway Children's Health and Rehabilitation Centre, St John's, NL); Keith Barrington (St. Justine's Hospital, Montreal, QC); Wendy Yee (Foothills Medical Centre, Calgary, AB); Barbara Bullied (Everett Chalmers Hospital, Fredericton, NB); Rody Canning (Moncton Hospital, Moncton, NB); Gerarda Cronin (St Boniface General Hospital, Winnipeg, MB); Kimberly Dow (Kingston General Hospital, Kingston, ON); Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, ON); Adele Harrison (Victoria General Hospital, Victoria, BC); Andrew James (Hospital for Sick Children, Toronto, ON); Zarin Kalapesi (Regina General Hospital, Regina, SK); Lajos Kovacs (Jewish General Hospital, Montreal, QC); Orlando da Silva (St Joseph's Health Centre; London, ON); Douglas D McMillan (IWK Health Centre, Halifax, NS); Prakesh Shah (Mount Sinai Hospital, Toronto, ON); Cecil Ojah (St John Regional Hospital, St John, NB); Abraham Peliowski / Khalid Aziz (Royal Alexandra Hospital, Edmonton, AB); Bruno Piedboeuf (Centre Hospitalier Universitaire de Quebec, Sainte Foy, QC); Patricia Riley (Montreal Children's Hospital, Montreal, QC); Daniel Faucher (Royal Victoria Hospital, Montreal, QC); Nicole Rouvinez-Bouali (Children's Hospital of Eastern Ontario, Ottawa, ON); Koravangattu Sankaran (Royal University Hospital, Saskatoon, SK); Mary Seshia (Health Sciences Centre, Winnipeg, MB); Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, ON); Zenon Cieslak (Royal Columbian Hospital, New Westminster, BC); Anne Synnes (Children's and Women's Health Centre of British Columbia, Vancouver, BC); Herve Walti (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, QC).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sgro, M., Shah, P., Campbell, D. et al. Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008. J Perinatol 31, 794–798 (2011). https://doi.org/10.1038/jp.2011.40

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2011.40

Keywords

This article is cited by

Search

Quick links