1
|
Bedetti L, Miselli F, Minotti C, Latorre G, Loprieno S, Foglianese A, Laforgia N, Perrone B, Ciccia M, Capretti MG, Giugno C, Rizzo V, Merazzi D, Fanaro S, Taurino L, Pulvirenti RM, Orlandini S, Auriti C, Haass C, Ligi L, Vellani G, Tzialla C, Tuoni C, Santori D, China M, Baroni L, Nider S, Visintini F, Decembrino L, Nicolini G, Creti R, Pellacani E, Dondi A, Lanari M, Benenati B, Biasucci G, Gambini L, Lugli L, Berardi A. Lumbar Puncture and Meningitis in Infants with Proven Early- or Late-Onset Sepsis: An Italian Prospective Multicenter Observational Study. Microorganisms 2023; 11:1546. [PMID: 37375048 DOI: 10.3390/microorganisms11061546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Background: To evaluate the rates of lumbar puncture (LP) in infants with culture-proven sepsis. Study design: We prospectively enrolled 400 infants with early- or late-onset sepsis due to Group B streptococcus (GBS) or Eschericha coli, diagnosed within 90 days of life. Rates of LP and potential variables associated with LP performance were evaluated. Moreover, cerebrospinal fluid (CSF) characteristics and results of the molecular analysis were investigated. Results: LP was performed in 228/400 (57.0%) infants; 123/228 LPs (53.9%) were performed after antibiotic initiation, hampering the ability to identify the pathogen in the CSF culture. However, polymerase chain reaction increased the probability of positive results of CSF analysis compared to microbiological culture (28/79, 35.4% vs. 14/79, 17.7%, p = 0.001). Severe clinical presentation and GBS infection were associated with higher LP rates. The rate of meningitis was 28.5% (65/228). Conclusions: Rates of LP are low in culture-proven neonatal sepsis and antibiotics are frequently given before LP is carried out. Thus meningitis may be underestimated, and the chances of giving an effective therapy to the newborn are reduced. LP should be performed before the start of antibiotics when there is a clinical suspicion of infection.
Collapse
Affiliation(s)
- Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 21124 Modena, Italy
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 21124 Modena, Italy
| | - Chiara Minotti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Giuseppe Latorre
- Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Sabrina Loprieno
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandra Foglianese
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Perrone
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Matilde Ciccia
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Maggiore Hospital, 40133 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Chiara Giugno
- Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy
| | - Vittoria Rizzo
- Neonatal Intensive Care Unit, Bufalini Hospital, 47521 Cesena, Italy
| | - Daniele Merazzi
- Division of Neonatology, "Valduce" Hospital, 22100 Como, Italy
| | - Silvia Fanaro
- Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy
| | - Lucia Taurino
- Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy
| | - Rita Maria Pulvirenti
- Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forli, Italy
| | - Silvia Orlandini
- Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy
| | - Laura Ligi
- Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulia Vellani
- Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
| | - Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Santori
- Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | | | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy
| | - Silvia Nider
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | | | - Lidia Decembrino
- ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy
| | | | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Elena Pellacani
- Residency in Pediatrics, Departmento of Medical and Surgical Science, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Belinda Benenati
- Pediatric and Neonatal Unit, Women's and Children's Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Giacomo Biasucci
- Pediatric and Neonatal Unit, Women's and Children's Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Lucia Gambini
- Neonatal Intensive Care Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| |
Collapse
|
2
|
Berardi A, Trevisani V, Di Caprio A, Caccamo P, Latorre G, Loprieno S, Foglianese A, Laforgia N, Perrone B, Nicolini G, Ciccia M, Capretti MG, Giugno C, Rizzo V, Merazzi D, Fanaro S, Taurino L, Pulvirenti RM, Orlandini S, Auriti C, Haass C, Ligi L, Vellani G, Tzialla C, Tuoni C, Santori D, Baroni L, China M, Bua J, Visintini F, Decembrino L, Creti R, Miselli F, Bedetti L, Lugli L. Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management? Pathogens 2023; 12:pathogens12040588. [PMID: 37111474 PMCID: PMC10140896 DOI: 10.3390/pathogens12040588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
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 E. coli culture-confirmed EOS cases. IAP was defined "active" when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 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 E. coli 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 E. coli 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.
Collapse
Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Viola Trevisani
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Antonella Di Caprio
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Paola Caccamo
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Giuseppe Latorre
- Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Sabrina Loprieno
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandra Foglianese
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Perrone
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | | | - Matilde Ciccia
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Maggiore Hospital, 40133 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Chiara Giugno
- Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy
| | - Vittoria Rizzo
- Neonatal Intensive Care Unit, Bufalini Hospital, Cesena, 47521 Cesena, Italy
| | - Daniele Merazzi
- Division of Neonatology, "Valduce" Hospital, 22100 Como, Italy
| | - Silvia Fanaro
- Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy
| | - Lucia Taurino
- Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy
| | - Rita Maria Pulvirenti
- Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forlì, Italy
| | - Silvia Orlandini
- Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy
| | - Laura Ligi
- Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulia Vellani
- Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
| | - Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Santori
- Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy
| | | | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, "IRCCS Burlo Garofolo", 34137 Trieste, Italy
| | | | - Lidia Decembrino
- ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy
| | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| |
Collapse
|
3
|
Esposito S, Sgarzani R, Bianchini S, Monaco S, Nicoletti L, Rigotti E, Di Pietro M, Opri R, Caminiti C, Ciccia M, Conti G, Donà D, Giuffré M, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Piacentini G, Pietrasanta C, Puntoni M, Simonini A, Venturini E, Staiano A, Principi N. Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11040506. [PMID: 35453257 PMCID: PMC9029976 DOI: 10.3390/antibiotics11040506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
- Correspondence: ; Tel.: +39-0521-903524
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Marilia Di Pietro
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Matilde Ciccia
- Neonatology and Neonatal Intensive Care Unit, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Carlo Pietrasanta
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Matteo Puntoni
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer’s Children Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | | | | |
Collapse
|
4
|
Berardi A, Spada C, Creti R, Auriti C, Gambini L, Rizzo V, Capretti M, Laforgia N, Papa I, Tarocco A, Lanzoni A, Biasucci G, Piccinini G, Nardella G, Latorre G, Merazzi D, Travan L, Reggiani MLB, Baroni L, Ciccia M, Lucaccioni L, Iughetti L, Lugli L. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerg Infect Dis 2021; 27:2279-2287. [PMID: 34423765 PMCID: PMC8386770 DOI: 10.3201/eid2709.210049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
At the time of late-onset disease, mothers often have positive breast milk culture or group B Streptococcus bacteriuria, suggesting heavy maternal colonization. We retrospectively investigated mother-to-infant transmission of group B Streptococcus (GBS) in 98 cases of late-onset disease reported during 2007–2018 by a network in Italy. Mothers with full assessment of vaginal/rectal carriage tested at prenatal screening and at time of late onset (ATLO) were included. Thirty-three mothers (33.7%) were never GBS colonized; 65 (66.3%) were vaginal/rectal colonized, of which 36 (36.7%) were persistently colonized. Mothers with vaginal/rectal colonization ATLO had high rates of GBS bacteriuria (33.9%) and positive breast milk culture (27.5%). GBS strains from mother–infant pairs were serotype III and possessed the surface protein antigen Rib. All but 1 strain belonged to clonal complex 17. GBS strains from 4 mother–infant pairs were indistinguishable through pulsed-field gel electrophoresis. At least two thirds of late-onset cases are transmitted from mothers, who often have vaginal/rectal carriage, positive breast milk culture, or GBS bacteriuria, which suggests heavy maternal colonization.
Collapse
|
5
|
Abstract
In spite of the increasing, accumulating knowledge on the novel pandemic coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), questions on the coronavirus disease-2019 (COVID-19) infection transmission from mothers to fetuses or neonates during pregnancy and peripartum period remain pending and have not been addressed so far. SARS-CoV-2, a RNA single-stranded virus, has been detected in the amniotic fluid, in the cord blood and in the placentas of the infected women. In the light of these findings, the theoretical risk of intrauterine infection for fetuses, or of peripartum infection occurring during delivery for neonates, has a biological plausibility. The extent of this putative risk might, however, vary during the different stages of pregnancy, owing to several variables (physiological modifications of the placenta, virus receptors' expression, or delivery route). This brief review provides an overview of the current evidence in this area. Further data, based on national and international multicenter registries, are needed not only to clearly assess the extent of the risk for vertical transmission, but also to ultimately establish solid guidelines and consistent recommendations. KEY POINTS: · Questions on the COVID-19 infection transmission from mothers to fetuses or neonates during pregnancy and peripartum period remain pending so far.. · The theoretical risk of intrauterine infection for fetuses, or of neonatal infection during delivery for neonates, has a biological plausibility.. · A caution is recommended in the interpretation of clinical and laboratory data in neonates..
Collapse
Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico “San Matteo,” Pavia, Italy
| | - Leonardo Caforio
- Fetal Medicine and Surgery Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy
| | - Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | - Mauro Stronati
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico “San Matteo,” Pavia, Italy
| |
Collapse
|
6
|
Berardi A, Sforza F, Baroni L, Spada C, Ambretti S, Biasucci G, Bolognesi S, Capretti M, Carretto E, Ciccia M, Lanari M, Pedna MF, Rizzo V, Venturelli C, Tzialla C, Lucaccioni L, Reggiani MLB. Epidemiology and complications of late-onset sepsis: an Italian area-based study. PLoS One 2019; 14:e0225407. [PMID: 31756213 PMCID: PMC6874360 DOI: 10.1371/journal.pone.0225407] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/03/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Most studies regarding late-onset sepsis (LOS) address selected populations (i.e., neonates with low birth weight or extremely preterm neonates). Studying all age groups is more suitable to assess the burden of single pathogens and their clinical relevance. METHODS This is a retrospective regional study involving paediatric departments and NICUs in Emilia-Romagna (Italy). Regional laboratory databases were searched from 2009 to 2012. Records of infants (aged 4 to 90 days) with a positive blood or cerebrospinal fluid (CSF) culture were retrospectively reviewed and analysed according to acquisition mode (whether hospital- or community-acquired). RESULTS During the study period, there were 146,682 live births (LBs), with 296 patients experiencing 331 episodes of LOS (incidence rate: 2.3/1000 LBs). Brain lesions upon discharge from the hospital were found in 12.3% (40/296) of cases, with death occurring in 7.1% (23/296; 0.14/1000 LBs). With respect to full-term neonates, extremely preterm or extremely low birth weight neonates had very high risk of LOS and related mortality (> 100- and > 800-fold higher respectively). Hospital-acquired LOS (n = 209) was significantly associated with very low birth weight, extremely preterm birth, pneumonia, mechanical ventilation, and death (p< 0.01). At multivariate logistic regression analysis, catecholamine support (OR = 3.2), central venous line before LOS (OR = 14.9), and meningitis (OR = 44.7) were associated with brain lesions or death in hospital-acquired LOS (area under the ROC curve 0.81, H-L p = 0.41). Commonly identified pathogens included coagulase-negative staphylococci (CoNS n = 71, 21.4%), Escherichia coli (n = 50, 15.1%), Staphylococcus aureus (n = 41, 12.4%) and Enterobacteriaceae (n = 41, 12.4%). Group B streptococcus was the predominant cause of meningitis (16 of 38 cases, 42%). Most pathogens were sensitive to first line antibiotics. CONCLUSIONS This study provides the first Italian data regarding late-onset sepsis (LOS) in all gestational age groups. Compared to full-term neonates, very high rates of LOS and mortality occurred in neonates with a lower birth weight and gestational age. Group B streptococcus was the leading cause of meningitis. Excluding CoNS, the predominant pathogens were Escherichia coli and Staphylococcus aureus. Neonates with hospital-acquired LOS had a worse outcome. Antibiotic associations, recommended for empirical treatment of hospital- or community-acquired LOS, were adequate.
Collapse
Affiliation(s)
- Alberto Berardi
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
- * E-mail:
| | - Francesca Sforza
- Medico in formazione, Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio, Modena, Italy
| | - Lorenza Baroni
- Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Caterina Spada
- Medico in formazione, Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio, Modena, Italy
| | - Simone Ambretti
- Unità Operativa di Microbiologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Giacomo Biasucci
- Unità Operativa di Pediatria, Ospedale G da Saliceto, Piacenza, Italy
| | - Serenella Bolognesi
- Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi, Rimini, Italy
| | - Mariagrazia Capretti
- Unità Operativa di Neonatologia, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant’Orsola–Malpighi, Bologna, Italy
| | - Edoardo Carretto
- Laboratorio di Microbiologia, Dipartimento Interaziendale di Diagnostica per Immagini e Medicina di Laboratorio, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Matilde Ciccia
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile, Ospedale Maggiore, Bologna, Italy
| | - Marcello Lanari
- Unità Operativa di Pediatria, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant’Orsola–Malpighi, Bologna, Italy
| | - Maria Federica Pedna
- Unità Operativa di Microbiologia, Laboratorio Unico Ausl della Romagna, Pievesestina Cesena, Italy
| | - Vittoria Rizzo
- Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini, Cesena, Italy
| | - Claudia Venturelli
- Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Crisoula Tzialla
- Neonatologia, Patologia Neonatale e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - Laura Lucaccioni
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Maria Letizia Bacchi Reggiani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi—Università di Bologna, Bologna, Italy
| |
Collapse
|
7
|
Ciccia M, Ambretti S, Guerra L, Sandri F. Verona integron-encoded metallo- β-lactamase-producing Klebsiella pneumoniae sepsis in an extremely premature infant. Case Reports in Perinatal Medicine 2018. [DOI: 10.1515/crpm-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
During the course of an outbreak due to Verona integron-encoded Metallo-β-lactamase (VIM)-producing Klebsiella pneumonia (KP) in the neonatal intensive care unit (NICU) of Maggiore Hospital in Bologna (Italy), an 8-day-old extremely low birth weight (ELBW) infant developed a severe ventilator-associated pneumonia (VAP) with concomitant bacteraemia. Although the microorganism was susceptible only to colistin and tigecycline, the patient was successfully treated with a combination of antibiotics including high-dosage, prolonged infusion of meropenem (MEM) and intravenous plus aerosolised gentamicin (GEN). This report highlights that, even when the microorganism is considered non-susceptible to MEM and GEN, the combination of these two agents could have a significant survival benefit.
Collapse
Affiliation(s)
- Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health , Maggiore Hospital , via dell’Ospedale 2 , 40131 Bologna , Italy , Tel.: 0039 051 3172424, Fax: 0039 051 3172419
| | - Simone Ambretti
- Institute of Microbiology , University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Luca Guerra
- Division of Infectious Diseases , University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health , Maggiore Hospital , Bologna , Italy
| |
Collapse
|
8
|
Ciccia M, Monari C, Vitagliano G, Zarro N, Sandri F. Usefulness of a flow chart for targeted screening of congenital cytomegalovirus-related hearing loss. J Neonatal Perinatal Med 2018; 11:339-343. [PMID: 30040746 DOI: 10.3233/npm-17110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Around 90% of congenital cytomegalovirus infected neonates are asymptomatic at birth. Among the infected infants showing no clinical abnormalities, 7 to 15% or over may develop sensorineural hearing loss and only about 50% of these cases are detectable at birth. In 2013, the Neonatal Intensive Care Unit at Maggiore Hospital in Bologna (Italy) introduced a one-page flow chart aimed at identifying neonates with unapparent congenital cytomegalovirus infection by means of selective cytomegalovirus screening of patients who failed to pass a hearing screening test. Since its introduction, 83 infants have been referred to our clinic for sample collection and two cases of congenital cytomegalovirus-related sensorineural hearing loss were diagnosed and treated at the appropriate time.
Collapse
Affiliation(s)
- Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| | | | - Gianna Vitagliano
- Department of Otorhinolaryngology, Maggiore Hospital, Bologna, Italy
| | - Nicola Zarro
- Department of Otorhinolaryngology, Maggiore Hospital, Bologna, Italy
| | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| |
Collapse
|
9
|
Ciccia M, Chakrokh R, Molinazzi D, Zanni A, Farruggia P, Sandri F. Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: A 2-year single-center experience. Am J Infect Control 2018; 46:169-172. [PMID: 28967509 DOI: 10.1016/j.ajic.2017.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
Abstract
AIM The study reports a 2-year single-center experience of the practice of skin antisepsis using a 0.05% sodium hypochlorite solution before central venous catheter placement in neonates. METHODS Eligible subjects included any hospitalized neonate who needed a central line for at least 48 hours. Infants were excluded if they had a generalized or localized skin disorder. An ad hoc Excel (Microsoft Corp, Redmond, WA) file was used to record the data from each patient. The catheter sites were monitored daily for the presence of contact dermatitis. Central line-associated bloodstream infection was diagnosed according to Centers for Disease Control and Prevention definition. RESULTS One hundred five infants underwent central venous catheter placement and were enrolled. A total of 198 central lines were inserted. The median gestational age was 31 weeks (range, 23-41 weeks) and median birth weight was 1,420 g (range, 500-5,170 g). There were no signs of 0.05% sodium hypochlorite-related skin toxicity in any infant. Of 198 catheters (1,652 catheter-days) prospectively studied, 9 were associated with bloodstream infections (5.4 per 1,000 catheter-days). CONCLUSION During the observation period, no local adverse effects were observed suggesting that 0.05% sodium hypochlorite may be a safe choice in this context.
Collapse
Affiliation(s)
- Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy.
| | - Roksana Chakrokh
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| | - Dario Molinazzi
- Management Control and Information Flow Unit, Local Health Authority, Bologna, Italy
| | - Angela Zanni
- Hospital Infection Control Unit, Local Health Authority, Bologna, Italy
| | | | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| |
Collapse
|
10
|
Berardi A, Spada C, Capretti MG, Ciccia M, Pulvirenti MR, Vezzosi M, Sandri F. Neonates at Risk of Early-Onset Sepsis: Which Is the Best Approach? Neonatology 2018; 114:167-168. [PMID: 29898454 DOI: 10.1159/000489293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Alberto Berardi
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Caterina Spada
- Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio, Modena, Italy
| | - Maria Grazia Capretti
- Unità Operativa di Neonatologia, Dipartimento del Bambino, della Donna e delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Matilde Ciccia
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile, Ospedale Maggiore, Bologna, Italy
| | | | - Martina Vezzosi
- Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Parma, Italy
| | - Fabrizio Sandri
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile, Ospedale Maggiore, Bologna, Italy
| |
Collapse
|
11
|
Ciccia M, Salerno A, Mascio AD, Berardi A, Chakrokh R, Sandri F. Gestational group B streptococcal infection in two twin pregnancies. Case Reports in Perinatal Medicine 2017. [DOI: 10.1515/crpm-2016-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Twin pregnancies represent an interesting pattern in which selective infection of one gestational sac over the other can occur. Despite the ubiquity of Group B streptococcus (GBS), only a few cases documenting twin gestational GBS infections have been reported. We describe two cases of gestational GBS infection in twin pregnancies (a monochorionic/diamniotic pregnancy and a dichorionic/diamniotic pregnancy) both resulting in the death of one twin.
Collapse
Affiliation(s)
- Matilde Ciccia
- Neonatology and Neonatal Intensive Care Unit, Women’s and Children’s Health Department, Maggiore Hospital , via dell’Ospedale 2 , 40131 Bologna , Italy
| | - Angela Salerno
- Service of Pathological Anatomy and Histology, Maggiore Hospital , Largo Nigrisoli 2 , 40131 Bologna , Italy
| | | | - Alberto Berardi
- Neonatal Intensive Care Unit, Polyclinic University Hospital , via del Pozzo 71 , 41124 Modena , Italy
| | - Roksana Chakrokh
- Neonatology and Neonatal Intensive Care Unit, Women’s and Children’s Health Department, Maggiore Hospital , via dell’Ospedale 2 , 40131 Bologna , Italy
| | - Fabrizio Sandri
- Neonatology and Neonatal Intensive Care Unit, Women’s and Children’s Health Department, Maggiore Hospital , via dell’Ospedale 2 , 40131 Bologna , Italy
| |
Collapse
|
12
|
Berardi A, Baroni L, Bacchi Reggiani ML, Ambretti S, Biasucci G, Bolognesi S, Capretti MG, Carretto E, Ciccia M, Fiorini V, Fortini C, Gargano G, Pedna MF, Rizzo V, Creti R, Ferrari F. The burden of early-onset sepsis in Emilia-Romagna (Italy): a 4-year, population-based study. J Matern Fetal Neonatal Med 2016; 29:3126-31. [PMID: 26515917 DOI: 10.3109/14767058.2015.1114093] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS. METHODS Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed. RESULTS Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight <1000 g (20.37/1000 LB and 8.49/1000 LB, respectively). The most common pathogens were GBS (n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coli EOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%). CONCLUSIONS GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate.
Collapse
Affiliation(s)
- Alberto Berardi
- a Dipartimento Integrato Materno-Infantile , Azienda Ospedaliero-Universitaria Policlinico, Unità Operativa di Terapia Intensiva Neonatale , Modena , Italy
| | - Lorenza Baroni
- b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy
| | | | - Simone Ambretti
- d Unità Operativa di Microbiologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi , Bologna , Italy
| | - Giacomo Biasucci
- e Unità Operativa di Pediatria, Ospedale G da Saliceto , Piacenza , Italy
| | - Serenella Bolognesi
- f Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi , Rimini , Italy
| | - Maria Grazia Capretti
- g Unità Operativa di Neonatologia, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant'orsola - Malpighi , Bologna , Italy
| | - Edoardo Carretto
- h Laboratorio di Microbiologia , Dipartimento Interaziendale di Diagnostica per Immagini e Medicina di Laboratorio, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy
| | - Matilde Ciccia
- i Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile , Ospedale Maggiore , Bologna , Italy
| | - Valentina Fiorini
- j Unità Operativa di Pediatria, Ospedale B Ramazzini , Carpi , Italy
| | - Cinzia Fortini
- k Unità Operativa di Terapia Intensiva Neonatale, Ospedale S. Anna , Ferrara , Italy
| | - Giancarlo Gargano
- b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy
| | - Maria Federica Pedna
- l Unità Operativa di Microbiologia, Laboratorio Unico Ausl della Romagna, Pievesestina Cesena , Italy
| | - Vittoria Rizzo
- m Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini , Cesena , Italy , and
| | - Roberta Creti
- n Reparto di Malattie Batteriche, Respiratorie e Sistemiche, Dipartimento MIPI, Istituto Superiore di Sanità , Roma , Italy
| | - Fabrizio Ferrari
- a Dipartimento Integrato Materno-Infantile , Azienda Ospedaliero-Universitaria Policlinico, Unità Operativa di Terapia Intensiva Neonatale , Modena , Italy
| | | |
Collapse
|
13
|
Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, Lanari M, Memo L, Pedna MF, Venturelli C, Perrone E, Ciccia M, Tridapalli E, Piepoli M, Contiero R, Ferrari F. Group B streptococcus late-onset disease: 2003-2010. Pediatrics 2013; 131:e361-8. [PMID: 23296441 DOI: 10.1542/peds.2012-1231] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is insufficient population-based data on group B streptococcus (GBS) late-onset disease (LOD). Risk factors and routes of GBS transmission are poorly understood. METHODS A prospective, cohort study was conducted to collect incidence data on LOD and evaluate GBS infections over an 8-year period (2003-2010). Starting from January 2007, maternal rectovaginal and breast milk cultures were routinely collected on confirmation of the LOD diagnosis to assess maternal GBS culture status. RESULTS The incidence rate of LOD was 0.32 per 1000 live births (1.4 and 0.24 per 1000 live births for preterm and term newborns, respectively). The registered cases of LOD (n = 100) were classified as sepsis (n = 57), meningitis (n = 36), or focal infection (n = 7). Thirty neonates were preterm (2 had recurrent infection); 68 were term. Four infants died (3 early preterm, 1 term). At the time the LOD diagnosis was confirmed, 3 (6%) of 53 mothers had GBS mastitis, and 30 (64%) of 47 carried GBS at the rectovaginal site. Early (7-30 days) LOD presentation was associated with neonatal brain lesions or death (odds ratio: 0.96 [95% confidence interval: 0.93-0.99]). Intrapartum antibiotic exposure was significantly associated with mild (12 of 22) rather than severe (11 of 45; P = .03) LOD. CONCLUSIONS Preterm neonates had the highest rates of LOD and mortality. Most mothers carried GBS at the time of the LOD diagnosis, whereas 6% had mastitis. Intrapartum antibiotics were associated both with delayed presentation of symptoms and milder LOD.
Collapse
Affiliation(s)
- Alberto Berardi
- Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71-41124 Modena (MO), Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Berardi A, Lugli L, Baronciani D, Creti R, Rossi K, Ciccia M, Gambini L, Mariani S, Papa I, Serra L, Tridapalli E, Ferrari F. Group B streptococcal infections in a northern region of Italy. Pediatrics 2007; 120:e487-93. [PMID: 17766492 DOI: 10.1542/peds.2006-3246] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Group B streptococcus is a leading cause of neonatal bacterial infections. Despite adoption of preventive strategies, cases of infection continue to occur and there is concern that widespread antimicrobial prophylaxis might delay rather than prevent disease onset, increasing the rates of late-onset diseases. OBJECTIVES The purpose of this study was to determine the incidence and clinical features of early- and late-onset group B streptococcus disease in a northern region of Italy where a screening-based approach had been proposed. METHODS A population-based study was prospectively conducted in Emilia-Romagna, Italy. Infections that occurred during 2003-2005 in infants aged <3 months were analyzed. RESULTS Among 112,933 live births, 56 cases of invasive disease (30 early- and 26 late-onset disease) were observed, giving an annual group B streptococcus disease incidence of 0.50 per 1000 live births. Eleven infants with early-onset disease showed no signs of illness or were mildly ill, whereas 19 had moderate-to-severe symptoms, and culture-proven meningitis was found in 2. Risk factors were detected in 12 women. Twenty-two mothers had antenatal screening; 5 were group B streptococcus colonized, but 17 were culture-negative. Prophylaxis was administered in 3 women. Three infants with late-onset diseases were mildly ill, whereas 23 had moderate-to-severe symptoms. Risk factors were found in 7 mothers. Late-onset diseases were clinically more severe than early-onset diseases; meningitis was diagnosed in 12 infants, and 4 of 26 died. CONCLUSIONS The incidence of early-onset disease was low. Some early infections were still observed because of negative screening results or missed opportunity for prevention. Late-onset diseases accounted for most meningitis cases and deaths. Strict adherence to protocols and adoption of optimal culture methods would further improve prevention of early-onset disease, but the aim of future strategies should be the prevention of all invasive diseases.
Collapse
Affiliation(s)
- Alberto Berardi
- Dipartimento Materno-Infantile, Unità Operativa di Assistenza Neonatale, Università di Modena e Reggio Emilia, Via del Pozzo, 71-41100 Modena, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Patanè R, Sciacca A, Bottaro G, Mauro L, Ciccia M, Sciuto C, Grigorio R. [The clinical pictures of rotavirus infection in childhood. Studies on the admissions to the Clinica Pediatrica di Catania in 1984-1988]. Pediatr Med Chir 1990; 12:525-9. [PMID: 1965027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The Authors carried out a Rotavirus investigation on the stools of 6057 children admitted in the Department of Pediatric and Pediatric Gastroenterology of Catania University, during the years 1984-1988. The stool samples of 264 children were found positive for Rotavirus. While 204 children presented gastrointestinal symptoms with diarrhoea, 12 had subclinical signs, 26 presented only respiratory symptoms and 22 had no clinical symptomatology. Moreover 122 children with diarrhoea had associated respiratory manifestations. In this study the authors punctualized that: 1) the most interested age was the first year of life; 2) there was no evidence in seasonal variations; 3) the respiratory tract was involved in high percentage of children (59.8%); 4) a transient lactase deficiency was supposed in every children with watery diarrhoea, but it was demonstrated only in 21 (10.3%).
Collapse
Affiliation(s)
- R Patanè
- Cattedra di Gastroenterologia Pediatrica, Università di Catania, Italia
| | | | | | | | | | | | | |
Collapse
|