Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston and Children's Memorial Hermann Hospital, Houston.
Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia.
JAMA Pediatr. 2020 Jul 1;174(7):e200593. doi: 10.1001/jamapediatrics.2020.0593. Epub 2020 Jul 6.
Early-onset sepsis (EOS) remains a potentially fatal newborn condition. Ongoing surveillance is critical to optimize prevention and treatment strategies.
To describe the current incidence, microbiology, morbidity, and mortality of EOS among a cohort of term and preterm infants.
DESIGN, SETTING, AND PARTICIPANTS: This prospective surveillance study included a cohort of infants born at a gestational age (GA) of at least 22 weeks and birth weight of greater than 400 g from 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from April 1, 2015, to March 31, 2017. Data were analyzed from June 14, 2019, to January 28, 2020.
Early-onset sepsis defined by isolation of pathogenic species from blood or cerebrospinal fluid culture within 72 hours of birth and antibiotic treatment for at least 5 days or until death.
A total of 235 EOS cases (127 male [54.0%]) were identified among 217 480 newborns (1.08 [95% CI, 0.95-1.23] cases per 1000 live births). Incidence varied significantly by GA and was highest among infants with a GA of 22 to 28 weeks (18.47 [95% CI, 14.57-23.38] cases per 1000). No significant differences in EOS incidence were observed by sex, race, or ethnicity. The most frequent pathogens were Escherichia coli (86 [36.6%]) and group B streptococcus (GBS; 71 [30.2%]). E coli disease primarily occurred among preterm infants (68 of 131 [51.9%]); GBS disease primarily occurred among term infants (54 of 104 [51.9%]), with 24 of 45 GBS cases (53.3%) seen in infants born to mothers with negative GBS screening test results. Intrapartum antibiotics were administered to 162 mothers (68.9%; 110 of 131 [84.0%] preterm and 52 of 104 [50.0%] term), most commonly for suspected chorioamnionitis. Neonatal empirical antibiotic treatment most frequently included ampicillin and gentamicin. All GBS isolates were tested, but only 18 of 81 (22.2%) E coli isolates tested were susceptible to ampicillin; 6 of 77 E coli isolates (7.8%) were resistant to both ampicillin and gentamicin. Nearly all newborns with EOS (220 of 235 [93.6%]) displayed signs of illness within 72 hours of birth. Death occurred in 38 of 131 infected infants with GA of less than 37 weeks (29.0%); no term infants died. Compared with earlier surveillance (2006-2009), the rate of E coli infection increased among very low-birth-weight (401-1500 g) infants (8.68 [95% CI, 6.50-11.60] vs 5.07 [95% CI, 3.93-6.53] per 1000 live births; P = .008).
In this study, EOS incidence and associated mortality disproportionately occurred in preterm infants. Contemporary cases have demonstrated the limitations of current GBS prevention strategies. The increase in E coli infections among very low-birth-weight infants warrants continued study. Ampicillin and gentamicin remained effective antibiotics in most cases, but ongoing surveillance should monitor antibiotic susceptibilities of EOS pathogens.
早发性败血症 (EOS) 仍然是一种潜在致命的新生儿疾病。持续监测对于优化预防和治疗策略至关重要。
描述特立尼达和多巴哥新生儿研究网络的一个队列中足月和早产儿 EOS 的当前发病率、微生物学、发病率和死亡率。
设计、地点和参与者：这项前瞻性监测研究包括 2015 年 4 月 1 日至 2017 年 3 月 31 日期间，来自 Eunice Kennedy Shriver 国立儿童健康与人类发展研究所新生儿研究网络的 18 个中心的至少 22 周妊娠龄 (GA) 和出生体重超过 400 克的婴儿队列。数据于 2019 年 6 月 14 日至 2020 年 1 月 28 日进行分析。
EOS 定义为出生后 72 小时内从血液或脑脊液培养中分离出致病物种，并至少接受 5 天的抗生素治疗或直至死亡。
在 217480 名新生儿中（每 1000 例活产中 1.08 [95%CI，0.95-1.23] 例），共发现 235 例 EOS 病例（127 例男性[54.0%]）。GA 差异显著，GA 为 22 至 28 周的婴儿发病率最高（每 1000 例活产中 18.47 [95%CI，14.57-23.38] 例）。性别、种族或民族之间 EOS 的发病率无显著差异。最常见的病原体是大肠杆菌（86 [36.6%]）和 B 组链球菌（GBS；71 [30.2%]）。E coli 疾病主要发生在早产儿（131 例中的 68 例[51.9%]）；GBS 疾病主要发生在足月儿（104 例中的 54 例[51.9%]），其中 45 例 GBS 病例中的 24 例（53.3%）见于 GBS 筛查试验结果为阴性的母亲所生婴儿。162 名母亲（68.9%；131 例早产中的 110 例[84.0%]和 104 例足月中的 52 例[50.0%]）接受了产时抗生素治疗，最常见的是疑似绒毛膜羊膜炎。新生儿经验性抗生素治疗最常包括氨苄西林和庆大霉素。所有 GBS 分离株均进行了检测，但仅检测到 81 株 E coli 分离株中的 18 株（22.2%）对氨苄西林敏感；77 株 E coli 分离株中的 6 株（7.8%）对氨苄西林和庆大霉素均耐药。几乎所有患有 EOS 的新生儿（235 例中的 220 例[93.6%]）在出生后 72 小时内出现疾病迹象。38 名 GA 小于 37 周的感染婴儿死亡（29.0%）；没有足月儿死亡。与早期监测（2006-2009 年）相比，极低出生体重（401-1500 g）婴儿的 E coli 感染率增加（每 1000 例活产中 8.68 [95%CI，6.50-11.60] vs 每 1000 例活产中 5.07 [95%CI，3.93-6.53]；P = .008）。
在这项研究中，EOS 的发病率和相关死亡率不成比例地发生在早产儿中。当代病例表明，目前 GBS 预防策略存在局限性。极低出生体重婴儿中 E coli 感染的增加需要进一步研究。氨苄西林和庆大霉素仍然是大多数情况下有效的抗生素，但应持续监测 EOS 病原体的抗生素敏感性。
