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Early-Onset Neonatal Sepsis – What Bugs – What Drugs?

June 2, 2020

Written by Clay Smith

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E. coli has become more common among premature infants with early-onset sepsis (<72 hours), even more so than group B strep (GBS). GBS is more common in term infants. E. coli resistance to ampicillin and gentamicin is increasing. Don’t be falsely reassured by negative maternal GBS screening.

Why does this matter?
The pathogens that cause illness can change over time. What is happening in the realm of early-onset sepsis among premature and term infants?

Know your bugs and drugs
This was a multicenter prospective study from a pediatric research network. Infants 22 weeks and up with positive blood or CSF culture, onset of illness < 72 hours of life, and antibiotics for at least 5 days were included. There were 235 cases, with a rate of 1 per 1000. E. coli was more common than GBS in premature infants. GBS was more common among term infants, over half of which had mothers who screened negative. E.coli was resistant to ampicillin in 22%; resistant to both ampicillin and gentamicin in 8%. Among infants <37 weeks gestation, 29% died; no term infants died. Know your local antibiotic resistance patterns, and make sure ampicillin and gentamicin will be effective.

Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies. JAMA Pediatr. 2020 May 4;e200593.doi: 10.1001/jamapediatrics.2020.0593. Online ahead of print.

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