Berardi Alberto, Trevisani Viola, Di Caprio Antonella, Caccamo Paola, Latorre Giuseppe, Loprieno Sabrina, Foglianese Alessandra, Laforgia Nicola, Perrone Barbara, Nicolini Giangiacomo, Ciccia Matilde, Capretti Maria Grazia, Giugno Chiara, Rizzo Vittoria, Merazzi Daniele, Fanaro Silvia, Taurino Lucia, Pulvirenti Rita Maria, Orlandini Silvia, Auriti Cinzia, Haass Cristina, Ligi Laura, Vellani Giulia, Tzialla Chryssoula, Tuoni Cristina, Santori Daniele, Baroni Lorenza, China Mariachiara, Bua Jenny, Visintini Federica, Decembrino Lidia, Creti Roberta, Miselli Francesca, Bedetti Luca, Lugli Licia
Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy.
School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy.
Pathogens. 2023 Apr 13;12(4):588. doi: 10.3390/pathogens12040588.
The effectiveness of "inadequate" intrapartum antibiotic prophylaxis (IAP administered < 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003-2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and culture-confirmed EOS cases. IAP was defined "active" when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an "inactive" IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP "adequate" seems the pathogen's antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.
“不足的”产时抗生素预防（IAP，在分娩前<4小时给药）在预防早发型败血症（EOS）方面的有效性存在争议。利用意大利前瞻性监测队列数据（2003 - 2022年），根据B族链球菌（GBS）症状发作时间和培养确诊的EOS病例来研究IAP的类型和持续时间。当培养物中产生的病原体敏感时，IAP被定义为“有效”。我们确定了263例EOS病例（GBS = 191例；其他 = 72例）。在GBS EOS病例中，25%接受了IAP（使用β-内酰胺类药物时IAP总是有效）。大多数暴露于IAP的GBS新生儿在出生时出现症状（67%）或仍无症状（25%），与IAP持续时间无关。在其他EOS病例中，60%暴露于IAP。然而，IAP仅在8%的病例中有效，这些新生儿保持无症状或在出生后6小时内出现症状。相比之下，大多数暴露于“无效”IAP的新生儿（52%）在出生后1至>48小时出现症状。定义IAP“充分”的关键因素似乎是病原体的抗菌敏感性而非其持续时间。暴露于有效抗菌药物的新生儿（GBS感染时经常出现这种情况），如果在出生后的前6小时内保持无症状，则可能未被感染。由于其他分离株通常对β-内酰胺类抗生素不敏感，暴露于IAP的新生儿在出生后经常出现EOS症状，长达出生后48小时及更久。
