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