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Mazabanda López DA, Urquia Martí L, Reyes Suárez D, Siguero Onrubia M, Borges Luján M, García-Muñoz Rodrigo F. Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation. J Pediatr (Rio J) 2024; 100:100-107. [PMID: 37758173 PMCID: PMC10751711 DOI: 10.1016/j.jped.2023.07.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To evaluate the efficiency of the sepsis risk calculator and the serial clinical observation in the management of late preterm and term newborns with infectious risk factors. METHOD Single-center, observational, two-phase cohort study comparing the rates of neonates born ≥35 weeks' gestation, ≥2000 g birthweight, and without major congenital anomalies, who were screened and/or received antibiotics for early-onset neonatal sepsis risk at our center during two periods, before (January/2018-June/2019) and after (July/2019-December/2020) the implementation of the sepsis risk calculator. RESULTS A total of 1796 (Period 1) and 1867 (Period 2) patients with infectious risk factors were included. During the second period, tests to rule out sepsis were reduced by 34.0 % (RR, 95 %CI): 0.66 (0.61, 0.71), blood cultures by 13.1 %: 0.87 (0.77, 0.98), hospital admissions by 13.5 %: 0.86 (0.76, 0.98) and antibiotic administration by 45.9 %: 0.54 (0.47, 0.63). Three cases of early-onset neonatal sepsis occurred in the first period and two in the second. Clinical serial evaluation would have detected all true cases. CONCLUSIONS The implementation of a sepsis risk calculator in the management of newborns ≥35 weeks GA, ≥2000 g birthweight, without major congenital anomalies, with infectious risk factors is safe and adequate to reduce laboratory tests, blood cultures, hospital admissions, and antibiotics administration. Serial clinical observation, in addition, could be instrumental to achieve or even improve this goal.
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Affiliation(s)
| | - Lourdes Urquia Martí
- Hospital Universitario Materno-Infantil de Las Palmas, Division of Neonatology, Las Palmas de Gran Canaria, Spain
| | - Desiderio Reyes Suárez
- Hospital Universitario Materno-Infantil de Las Palmas, Division of Neonatology, Las Palmas de Gran Canaria, Spain
| | - Marta Siguero Onrubia
- Hospital Universitario Materno-Infantil de Las Palmas, Division of Neonatology, Las Palmas de Gran Canaria, Spain
| | - Moreyba Borges Luján
- Hospital Universitario Materno-Infantil de Las Palmas, Division of Neonatology, Las Palmas de Gran Canaria, Spain
| | - Fermín García-Muñoz Rodrigo
- Hospital Universitario Materno-Infantil de Las Palmas, Division of Neonatology, Las Palmas de Gran Canaria, Spain.
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Dos Anjos Borges LG, Pastuschek J, Heimann Y, Dawczynski K, Schleußner E, Pieper DH, Zöllkau J. Vaginal and neonatal microbiota in pregnant women with preterm premature rupture of membranes and consecutive early onset neonatal sepsis. BMC Med 2023; 21:92. [PMID: 36907851 PMCID: PMC10009945 DOI: 10.1186/s12916-023-02805-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM), which is associated with vaginal dysbiosis, is responsible for up to one-third of all preterm births. Consecutive ascending colonization, infection, and inflammation may lead to relevant neonatal morbidity including early-onset neonatal sepsis (EONS). The present study aims to assess the vaginal microbial composition of PPROM patients and its development under standard antibiotic therapy and to evaluate the usefulness of the vaginal microbiota for the prediction of EONS. It moreover aims to decipher neonatal microbiota at birth as possible mirror of the in utero microbiota. METHODS As part of the PEONS prospective multicenter cohort study, 78 women with PPROM and their 89 neonates were recruited. Maternal vaginal and neonatal pharyngeal, rectal, umbilical cord blood, and meconium microbiota were analyzed by 16S rRNA gene sequencing. Significant differences between the sample groups were evaluated using permutational multivariate analysis of variance and differently distributed taxa by the Mann-Whitney test. Potential biomarkers for the prediction of EONS were analyzed using the MetaboAnalyst platform. RESULTS Vaginal microbiota at admission after PPROM were dominated by Lactobacillus spp. Standard antibiotic treatment triggers significant changes in microbial community (relative depletion of Lactobacillus spp. and relative enrichment of Ureaplasma parvum) accompanied by an increase in bacterial diversity, evenness and richness. The neonatal microbiota showed a heterogeneous microbial composition where meconium samples were characterized by specific taxa enriched in this niche. The vaginal microbiota at birth was shown to have the potential to predict EONS with Escherichia/Shigella and Facklamia as risk taxa and Anaerococcus obesiensis and Campylobacter ureolyticus as protective taxa. EONS cases could also be predicted at a reasonable rate from neonatal meconium communities with the protective taxa Bifidobacterium longum, Agathobacter rectale, and S. epidermidis as features. CONCLUSIONS Vaginal and neonatal microbiota analysis by 16S rRNA gene sequencing after PPROM may form the basis of individualized risk assessment for consecutive EONS. Further studies on extended cohorts are necessary to evaluate how far this technique may in future close a diagnostic gap to optimize and personalize the clinical management of PPROM patients. TRIAL REGISTRATION NCT03819192, ClinicalTrials.gov. Registered on January 28, 2019.
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Affiliation(s)
- Luiz Gustavo Dos Anjos Borges
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124, Brunswick, Germany
| | - Jana Pastuschek
- Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Kristin Dawczynski
- Center for Sepsis Control and Case (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Department of Pediatrics, Section Neonatology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | | | - Ekkehard Schleußner
- Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124, Brunswick, Germany.
| | - Janine Zöllkau
- Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Ji H, Yu Y, Huang L, Kou Y, Liu X, Li S, Zhang Y, Li Z, Sun X, Wang J, Yang K, Zhou L, Luo Y, Zhao G, Yang Z, Zhang X, Cui X, Li J, Wang Y, Shi J, Chen W, Ma Y, Zhao P, Zhao R, Zhou K, Li B, Zhu R, Gao Y, Zhou Z, Li H, Dou J, Li H, Zhao C, Zhang B, Wang X. Pathogen Distribution and Antimicrobial Resistance of Early Onset Sepsis in Very Premature Infants: A Real-World Study. Infect Dis Ther 2022. [PMID: 35999433 DOI: 10.1007/s40121-022-00688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Early onset sepsis (EOS) remains a potentially fatal newborn condition, especially in very preterm infants. Data on the pathogen distribution and antibiotic susceptibility patterns of EOS among very preterm infants are scarce but essential for the choice of empirical antibiotic administration. We sought to assess the epidemiologic characteristics and antibiotic susceptibility patterns of pathogens causing EOS among a cohort of very preterm infants in China. METHODS This prospective, observational study included a cohort of infants born at a gestational age (GA) less than 32 weeks of 32 newborn intensive care units (NICUs) in China between January 1, 2018 and December 31, 2020. EOS was defined by isolation of pathogenic species from blood culture within 72 h of birth. RESULTS A total of 108 EOS cases (18.4 per 1000 admissions) were identified among 5865 very preterm infants. Incidence of EOS increased with the decrease of GA and birthweight. Escherichia coli (n = 44, 40.7%) was the most common pathogen, followed by Klebsiella spp. (n = 10, 9.3%). The distribution and proportion of pathogenic bacteria varied significantly by GA. E. coli and Klebsiella spp. showed high resistance to ampicillin and third-generation cephalosporins, while they showed good susceptibility to carbapenem antibiotics and piperacillin-tazobactam. CONCLUSION Our data demonstrated that pathogens causing neonatal EOS showed high rates of resistance to ampicillin and third-generation cephalosporins. This raised questions about the best empirical antibiotic choice for preterm infants suspected of having EOS in low- and middle-income countries (LMICs).
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Morowitz MJ, Katheria AC, Polin RA, Pace E, Huang DT, Chang CCH, Yabes JG. The NICU Antibiotics and Outcomes (NANO) trial: a randomized multicenter clinical trial assessing empiric antibiotics and clinical outcomes in newborn preterm infants. Trials 2022; 23:428. [PMID: 35606829 PMCID: PMC9125935 DOI: 10.1186/s13063-022-06352-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early-onset sepsis is an important cause of neonatal morbidity and mortality in the preterm population. Infants perceived to be at increased risk for early-onset sepsis are often treated empirically with broad-spectrum antibiotics while awaiting confirmatory blood cultures, despite an overall incidence of early-onset sepsis of 2–3% among extremely-low-birthweight (ELBW) infants. Recent observational studies associate perinatal antibiotic use with an increased incidence of necrotizing enterocolitis, late-onset sepsis, and mortality among ELBW infants. Given currently available data and variability in clinical practice, we designed a prospective multi-institutional randomized controlled trial to determine the safety of early antibiotic use in ELBW infants. Methods The NICU Antibiotics and Outcomes (NANO) trial is a multicenter, double-blinded, randomized controlled trial. A sample of 802 ELBW preterm infants will undergo web-based stratified block randomization to receive empiric antibiotics (EA; ampicillin and gentamicin) or placebo during routine evaluation for early-onset sepsis. Participating sites will use preexisting institutional protocols for antibiotic dosage and duration. Infants born at participating sites with a gestational age of 29 weeks or less are eligible for enrollment. Exclusion criteria include maternal intrauterine infection, hemodynamic or respiratory instability, delivery by caesarean section for maternal indications without labor or prolonged rupture of membranes, and prior administration of antibiotics. The primary outcome is the composite incidence of necrotizing enterocolitis, late-onset sepsis, or death during participants’ index hospitalization. Maternal and infant samples will be collected longitudinally and assessed for differences in microbiome composition and diversity. Discussion The NANO trial is designed to compare the rate of adverse outcomes of EA use at birth versus placebo in ELBW preterm infants. If EA at birth worsens clinical outcomes, then the results of the trial may help providers decrease antibiotic utilization in the NICU and subsequently decrease the incidence of complications associated with early antibiotic use in ELBW infants. If we instead find that EA improve outcomes, then the trial will validate a longstanding clinical practice that has not previously been supported by high-quality data. Future studies will assess long-term clinical and microbial outcomes in infants who received empiric antibiotics following delivery. Trial registration Trial registration data: June 25, 2019 NCT03997266. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06352-3.
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Affiliation(s)
- Michael J Morowitz
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Rangos Research Center 6th Floor, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
| | - Anup C Katheria
- Division of Pediatrics, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, 92123, USA
| | - Richard A Polin
- Department of Pediatrics, Columbia University, New York, NY, 10032, USA
| | - Elizabeth Pace
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - David T Huang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Chung-Chou H Chang
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Johathan G Yabes
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, USA
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Al-Biltagi M, Hantash EM, El-Shanshory MR, Badr EA, Zahra M, Anwar MH. Plasma D-dimer level in early and late-onset neonatal sepsis. World J Crit Care Med 2022; 11:139-148. [PMID: 36331988 PMCID: PMC9136721 DOI: 10.5492/wjccm.v11.i3.139] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/09/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neonatal sepsis is a life-threatening disease. Early diagnosis is essential, but no single marker of infection has been identified. Sepsis activates a coagulation cascade with simultaneous production of the D-dimers due to lysis of fibrin. D-dimer test reflects the activation of the coagulation system.
AIM To assess the D-dimer plasma level, elaborating its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.
METHODS The study was a prospective cross-sectional study that included ninety neonates; divided into three groups: Group I: Early-onset sepsis (EOS); Group II: Late-onset sepsis (LOS); and Group III: Control group. We diagnosed neonatal sepsis according to our protocol. C-reactive protein (CRP) and D-dimer assays were compared between EOS and LOS and correlated to the causative microbiological agents.
RESULTS D-dimer was significantly higher in septic groups with a considerably higher number of cases with positive D-dimer. Neonates with LOS had substantially higher levels of D-dimer than EOS, with no significant differences in CRP. Neonates with LOS had a significantly longer hospitalization duration and higher gram-negative bacteriemia and mortality rates than EOS (P < 0.01). Gram-negative bacteria have the highest D-dimer levels (Acinetobacter, Klebsiella, and Pseudomonas) and CRP (Serratia, Klebsiella, and Pseudomonas); while gram-positive sepsis was associated with relatively lower levels. D-dimer had a significant negative correlation with hemoglobin level and platelet count; and a significant positive correlation with CRP, hospitalization duration, and mortality rates. The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L, giving a sensitivity of 72.7% and specificity of 86.7%. The D-dimer assay has specificity and sensitivity comparable to CRP in the current study.
CONCLUSION The current study revealed a significant diagnostic value for D-dimer in neonatal sepsis. D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.
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Affiliation(s)
- Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
- Department of Pediatrics, University Medical Center, Bahrain, Dr. Sulaiman Al Habib Medical Group, KSA, Manama 26671, Manama, Bahrain
| | - Ehab M Hantash
- Department of Anatomy, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Neonatology Unit, Department of Pediatrics, Dr. Sulaiman Al Habib Medical Group, Riyadh 11636, Riyadh, Saudi Arabia
| | | | - Enayat Aly Badr
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
| | - Mohamed Zahra
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
| | - Manar Hany Anwar
- Department of Clinical Pathology, Ministry of Health, Egypt, Tanta 31511, Alghrabia, Egypt
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Schmitt C, Novy M, Hascoët JM. Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test. Arch Pediatr 2021; 28:117-122. [PMID: 33446431 DOI: 10.1016/j.arcped.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/15/2020] [Revised: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early-onset neonatal sepsis is a rare but potentially lethal infection that is very often suspected in daily practice. Previous national guidelines recommended the use of systematic paraclinical tests for healthy term newborns with suspected infection. These guidelines were updated in 2017 by the French Health Authority (Haute Autorité de santé), and promote initial clinical monitoring taking into account the infectious risk level for term and near-term born infants. OBJECTIVES To assess the impact of the new recommendations on antibiotic therapy prescription and invasive tests, and on the outcomes of infants born from 36weeks' gestation. MATERIALS AND METHODS This study compared the management and the outcome of neonates born from 36weeks' gestation at the level III University Hospital of Nancy, according to their infectious risk level during two periods, before and after the update of national recommendations: from July 1 to December 31, 2017, versus July 1 to December 31, 2018. Data were retrospectively collected from the infants' files. This study compared the number and length of antibiotic treatment and the number of invasive tests, the number of documented infections, the number and length of hospitalization, and mortality between the two periods. RESULTS During the first period, among 1248 eligible newborns, 643 presented an infectious risk factor, versus 1152 newborns with 343 having an infectious risk factor during the second period. Antibiotic treatment was initiated for 18 newborns during the first period (1.4%) and for nine during the second (0.8%) (P=0.13). The mean (SD) duration of the antibiotic treatment was longer in the first than in the second period: 6.3±2days vs. 3.1±2.3days (P=0.003). There was no death related to neonatal infection. A total of 1052 blood samples were collected during the first period versus 51 during the second (P<0.01). There was no documented infection. In the first period, there were 18 newborns (1.4%) hospitalized for suspected infection versus nine (0.8%) in the second period (P=0.13). The duration of hospitalization was 5.7±1.7days in the first period versus 5.2±3days in the second (P=0.33). CONCLUSION In this study, the application of the new guidelines enabled a reduction of antibiotic exposure and a reduction of invasive tests without additional risk.
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Affiliation(s)
- C Schmitt
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France.
| | - M Novy
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France
| | - J-M Hascoët
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France; DevAH, Lorraine University, 54000 Nancy, France
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Cabaret B, Latry V. Application of HAS 2017 guidelines for asymptomatic neonates born at ≥34 weeks' gestation at risk of early-onset neonatal sepsis in a level-2 maternity department. Arch Pediatr 2021; 28:159-165. [PMID: 33446432 DOI: 10.1016/j.arcped.2020.12.007] [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: 03/27/2020] [Revised: 08/30/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022]
Abstract
The 2017 Haute Autorité de santé (HAS) guidelines for the medical care of neonates born at≥34 weeks' gestation (WG) at risk of early-onset neonatal sepsis (EONS) placed emphasis on clinical examination rather than laboratory tests. AIM Were these guidelines relevant in our level-2 maternity department, and how can they affect our professional practice? METHODS Single-site observational study of asymptomatic 35 WG neonates at risk of EONS, born in the centre hospitalier de Bigorre, with follow-up analysis during two 5-month periods (from September 2017 to January 2018, and September 2018 to January 2019), before and after the publication of the HAS guidelines. The main objective was feasibility, evaluated by checking the completion of a standardised assessment chart. The second objective was the impact of the guidelines on professional practices evaluated by the number of laboratory tests carried out during the two periods. RESULTS Out of 455 births during the first period and the 396 births during the second, 78 (17,1%) and 50 (12,6%) newborns, respectively, at risk of EONS were included. Those two groups had statistically similar characteristics. Overall, 49 (98%) assessment charts were satisfactorily completed for the 50 newborns. The number of laboratory tests decreased significantly (P<0.01): During the first period, all the newborns (78, 100%) had a C-reactive protein (CRP) test and 66 (84,6%) had a gastric fluid culture, versus one (2%) CRP and three (6%) gastric fluid cultures during the second period. CONCLUSION The HAS guidelines, emphasising repeated clinical assessment of newborns at risk of EONS rather than laboratory, were considered to be feasible in our maternity department. They led to an improvement in our professional practices and a reduction in laboratory procedures.
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Affiliation(s)
- B Cabaret
- Pediatric department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France.
| | - V Latry
- Research department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France
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Yochpaz S, Friedman N, Zirkin S, Blumovich A, Mandel D, Marom R. C-reactive protein in early-onset neonatal sepsis - a cutoff point for CRP value as a predictor of early-onset neonatal sepsis in term and late preterm infants early after birth? J Matern Fetal Neonatal Med 2020; 35:4552-4557. [PMID: 33280469 DOI: 10.1080/14767058.2020.1856068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/22/2022]
Abstract
OBJECTIVE To identify whether the first plasma C-reactive protein values taken 6-8 h postpartum are predictive of the clinical early-onset neonatal sepsis (cEONS). STUDY DESIGN We retrospectively analyzed C-reactive protein (CRP) values of 400 neonates, including 28 with cEONS, who underwent plasma CRP measurements as part of sepsis work-up. To determine whether the first CRP measurement is predictive of cEONS, logistic regression was used with CRP as an independent variable and cEONS (yes/no) as a dependent variable. RESULT A moderate predictive ability of the first CRP measurement (odds ratio 1.4, CI: [1.13, 1.76], p=.003) was revealed, at a 5.3 mg/L threshold. However, it resulted in poor sensitivity of 50%, and a false positive rate of 30%. Increasing the sensitivity to 75% or 90% lead to increased false-positive rates of 55% and 75%, respectively. CONCLUSIONS Our findings suggest that the first CRP value taken in neonates is a weak predictor of cEONS.
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Affiliation(s)
- Sivan Yochpaz
- Department of Neonatology, Faculty of Medicine, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Nati Friedman
- Department of Neonatology, Faculty of Medicine, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Semyon Zirkin
- Department of Neonatology, Faculty of Medicine, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Amit Blumovich
- Department of Neonatology, Faculty of Medicine, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Faculty of Medicine, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ronella Marom
- Department of Neonatology, Faculty of Medicine, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Glikman D, Curiel N, Glatman‐Freedman A, Megged O, Youngster I, Marom R, Lavie K, Smolkin T, Troitzky M, Stein M, Stein M, Glikman D, Curiel N, Glatman‐Freedman A, Megged O, Eventov‐Fiedman S, Keller N, Kriger O, Somekh E, Tasher D, Gottesman G, Guri A, Ashkenazi‐Hoffnung L, Ben‐Zvi H, Youngster I, Herzlich J, Schindler Y, Marom R, Rubinstein U, Midlij E, Miron D, Damouni R, Kassis I, Nimri‐Atrash N, Freiman S, Lavie K, Smolkin T, Melamed R, Troitzky M, Sayag A. Nationwide epidemiology of early-onset sepsis in Israel 2010-2015, time to re-evaluate empiric treatment. Acta Paediatr 2019; 108:2192-2198. [PMID: 31168848 DOI: 10.1111/apa.14889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/25/2023]
Abstract
AIM Early-onset neonatal sepsis (EOS) may lead to significant morbidity and mortality, yet the recommended antimicrobials have not changed for many years. We aimed to optimise EOS treatment by examining EOS pathogens, resistance rates and resistance risk factors. METHODS A retrospective, nationwide cohort study analysing 2010-2015 EOS data in Israel. RESULTS The 21 participating centres constitute 92% of the total birth cohort (around 180 000 live births/year). Of 549 EOS neonates (0.57/1000 live births), 306 (56%) and 243 (44%) were full-term and preterm, respectively (0.35 vs. 2.94 per/1000 live births). Gram-negative pathogens predominated, especially in preterms. Escherichia coli and Streptococcus agalactiae were most common pathogens (0.2 and 0.19 per 1000 live births, respectively). In 277 Gram-negatives, 16%, 14%, 8% and 3% were gentamicin-resistant, extended-spectrum beta-lactamase (ESBL)-positive, gentamicin-resistant and ESBL-positive, and amikacin-resistant, respectively; preterms had higher resistance rates. No risk factors for antimicrobial resistance were identified. Mortality was reported in 21% of Gram-negative EOS versus 7% of Gram-positive EOS [OR 3.4 (95% CI 1.8-6.2), p < 0.01]. CONCLUSION In this nationwide study, EOS was caused predominantly by Gram-negatives, with high gentamicin resistance and ESBL phenotype rates, without identifiable resistance risk factors. As EOS is life-threatening, modification of empiric therapy for amikacin-based regimens should be considered, mainly in preterms.
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Affiliation(s)
- Daniel Glikman
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Nitzan Curiel
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Aharona Glatman‐Freedman
- Israel Centre for Disease Control Tel Hashomer Ramat Gan Israel
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
| | - Orli Megged
- Paediatrics Shaare Zedek Medical Center Jerusalem Israel
- The School of Medicine The Hebrew University and Hadassah Medical Centre Jerusalem Israel
| | - Ilan Youngster
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Paediatrics, Centre for Microbiome Research Assaf Harofeh Medical Centre Zerifin Israel
| | - Ronella Marom
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Neonatology Tel Aviv Medical Centre Tel Aviv Israel
| | - Karen Lavie
- Neonatology Carmel Medical Centre Haifa Israel
- Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
| | - Tatiana Smolkin
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Neonatology Baruch Padeh Medical Centre Poria Israel
| | - Mara Troitzky
- Neonatology Barzilai Medical Centre Ashkelon Israel
- Ben‐Gurion University of the Negev Be'er Sheva Israel
| | - Michal Stein
- Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Infectious disease and infection control unit Hillel Yaffe Medical Centre Hadera Israel
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Suryavanshi A, Kalra R. Study of Association of C-Reactive Protein with Maternal Chorioamnionitis and Early-Onset Neonatal Sepsis in Premature Rupture of Membranes Deliveries: A Diagnostic Dilemma. Int J Appl Basic Med Res 2019; 9:236-240. [PMID: 31681550 PMCID: PMC6822317 DOI: 10.4103/ijabmr.ijabmr_119_19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/25/2019] [Accepted: 09/11/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Term prelabor rupture of membranes and preterm premature rupture of membranes (PROM), both pose significant risk to the mother and the fetus. Early identification of sepsis is essential as the mother has risk of chorioamnionitis and neonate is at the risk of early-onset sepsis. Aim To evaluate the diagnostic value of positive maternal C-reactive protein (CRP) in association with maternal clinical chorioamnionitis and early-onset neonatal sepsis (EONS) in PROM deliveries after 28 weeks of gestation. Methodology The study was conducted at People's College of Medical Science and Research Centre, Bhopal, from June 1, 2017, to May 31, 2018. Maternal serum CRP test was correlated to the signs of maternal chorioamnionitis and signs of EONS within 72 h of life. Results The maternal CRP test was compared to clinical signs of chorioamnionitis. Sensitivity of CRP for diagnosing maternal chorioamnionitis was 48% (95% confidence interval [CI] -35.99-61.12), specificity was 81 (95% CI 71.55%-88.98%), and odds ratio of maternal chorioamnionitis was 4.1176 (95% CI 1.99-8.51) with P < 0.0001. Sensitivity of positive maternal CRP in diagnosing EONS was 56.67% (95% CI 43.24%-69.41%), specificity was 84.78% (95% CI 75.79%-91.42%), and odds ratio of neonatal sepsis in maternal CRP positive was 7.28 (95%CI 3.39-15.64) with P < 0.0001. Conclusion Our study suggests that in PROM deliveries, if maternal CRP test is positive, then it indicates early delivery and neonate screening for EONS.
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Affiliation(s)
- Aabha Suryavanshi
- Department of Obstetrics and Gynecology, People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Ruchi Kalra
- Department of Obstetrics and Gynecology, People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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Gudayu TW, Zeleke EG, Lakew AM. The role of the season at admission in neonatal sepsis: a retrospective chart review of a 1-year data at University of Gondar comprehensive specialized hospital. BMC Res Notes 2019; 12:643. [PMID: 31585546 PMCID: PMC6778382 DOI: 10.1186/s13104-019-4685-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/28/2019] [Indexed: 01/18/2023] Open
Abstract
Objective Neonatal sepsis is a global public health concern in general and causes a massive burden in developing countries particularly in sub-Saharan Africa. Though it is mostly preventable, neonatal sepsis remained the leading cause of mortality in developing countries. This study was conducted to determine the current proportion and identify factors associated with neonatal sepsis to suggest directions. Results In this study 504 randomly selected neonatal charts were reviewed. The proportion of overall neonatal sepsis was 63.69% (95% CI 59.38, 67.79), where early-onset sepsis was 59.33% (95% CI 54.96, 63.55) and late-onset sepsis was 4.17% (95% CI 2.73, 6.31). Maternal intra-partum fever, season of birth and admission, vaginal mode of delivery and preterm gestational age at birth increased the likelihood of overall and early-onset neonatal sepsis. In conclusion of this study, neonatal sepsis remaining the leading cause of morbidity among younger infants. Intra-partum conditions were major contributors to neonatal sepsis. Thus, providing emphasis on associated factors in particular and universal safe obstetric care in general is recommended.
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Affiliation(s)
- Temesgen Worku Gudayu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mirsky R, Carpenter DM, Postlethwaite DA, Regenstein AC. Preventing early-onset group B streptococcal sepsis: is there a role for rescreening near term? J Matern Fetal Neonatal Med 2019; 33:3791-3797. [PMID: 30890002 DOI: 10.1080/14767058.2019.1586874] [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: 10/27/2022]
Abstract
Objective: The Centers for Disease Control and Prevention 2010 guidelines recommend group B streptococcus (GBS) screening at 35-37-week gestation to identify women with positive cultures who should receive intrapartum antibiotics and notes that the predictive value of a negative culture declines after 5 weeks. However, despite the lack of evidence, current guidelines do not recommend rescreening for those screened between 35 and 37 weeks. Our objectives were to investigate the rate of conversion from negative to positive results in women rescreened after appropriate screening at 35-37-week gestation and to examine the impact of rescreening on the use of intrapartum antibiotics. Additionally, we examined cases of early-onset group B streptococcal sepsis (early-onset GBS) in term neonates.Methods: We performed a retrospective cohort study of women delivering liveborn infants 1 January, 2010-31 December, 2014 in Kaiser Permanente Northern California. Data were obtained from database extraction and chart review.Results: We identified 135,585 women with GBS screening at 35-37-week gestation; 4511 (3.3%) women were rescreened. Of the 3860 (85.6%) initially screened negative, 218 (5.6%) converted to positive. Fewer women in the discordant negative to positive group received GBS prophylaxis prior to delivery compared with women with a single positive culture (65.9 versus 92.3%, p < .001). In the discordant negative to positive group, results were available at the time of delivery in 133 of 217 subjects (61.3%). There were 18 cases of early-onset GBS at term (0.10 per 1000 livebirths); the majority of cases occurred among women with negative screening.Conclusion: Our results provide support for the current CDC recommendation against rescreening near term for those women already screened at 35-37-week gestation given the low rate of conversion from negative to positive, and the extremely low rate of early-onset GBS in the screened population.
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Affiliation(s)
- Rachel Mirsky
- Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, California, USA
| | | | | | - Anne C Regenstein
- Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, California, USA
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Drageset M, Fjalstad JW, Mortensen S, Klingenberg C. Management of early-onset neonatal sepsis differs in the north and south of Scandinavia. Acta Paediatr 2017; 106:375-381. [PMID: 27935180 DOI: 10.1111/apa.13698] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/29/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Abstract
AIM This study compared the management and outcomes of early-onset neonatal sepsis (EONS) in two tertiary neonatal units in Denmark and Norway. METHODS We retrospectively studied all infants diagnosed with EONS between April 2010 and March 2013 and managed at Odense University Hospital, Denmark, and the University Hospital of North Norway, Norway. Clinical and laboratory data were collected from patient records. RESULTS We identified 137 EONS cases in Denmark and 101 in Norway. There were 35 culture-confirmed EONS cases: 16% of the Danish cases and 13% of the Norwegian cases. Staphylococcus aureus was the most frequently detected pathogen in 11 cases (31%), followed by Group B streptococci in nine (26%) and Escherichia coli in six (17%). In 85% of the 238 cases, the empiric therapy comprised gentamicin and a beta-lactam, namely ampicillin in Denmark and benzylpenicillin in Norway. Patients with positive blood cultures had higher C-reactive protein levels than patients with negative blood cultures and higher sepsis-attributable mortality. Lumbar punctures were performed more frequently in Denmark. CONCLUSION There were marginal differences in the management of EONS between units in Denmark and Norway, mainly in their choice of antibiotics and the use of lumbar punctures. Staphylococcus aureus was the most common pathogen.
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Affiliation(s)
- Martin Drageset
- Paediatric Research Group; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Nordland Hospital; Vesterålen Norway
| | - Jon Widding Fjalstad
- Paediatric Research Group; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - Sven Mortensen
- Hans Christian Andersen Childrens Hospital; Odense University Hospital; Odense Denmark
| | - Claus Klingenberg
- Paediatric Research Group; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Paediatrics; University Hospital of North Norway; Tromsø Norway
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14
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Resch B, B R, N H. Comparison Between Pathogen Associated Laboratory and Clinical Parameters in Early-Onset Sepsis of the Newborn. Open Microbiol J 2016; 10:133-9. [PMID: 27478518 PMCID: PMC4939603 DOI: 10.2174/1874285801610010133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To identify laboratory and clinical characteristics of different pathogens associated with early-onset sepsis (EOS) of the newborn. METHODS Newborns with EOS were retrospectively analyzed regarding laboratory and clinical parameters associated with the identified pathogen. RESULTS We identified 125 newborns having diagnosis of culture proven EOS between 1993 and 2011. One hundred cases had diagnosis of group B streptococci (GBS) infection (80%), 11 had Escherichia coli (8.8%), eight enterococci (6.4%), and six other pathogens (4.8%). White blood cell count (WBC), immature to total neutrophil (IT) ratio, and C-reactive protein (CRP) values did not differ between groups within the first 72 hours of life. Presence of high (>30000/µL) and low (<9000/µl) WBC was significantly less found compared with IT-ratio >0.2 in GBS and E.coli EOS. High WBC were more common found than low WBC in all groups. Gram positive pathogens were more common found in late preterm and term infants (84%), and gram negative pathogens more common in very low birth weight infants (64%). E. coli was significantly associated with lower gestational age and birth weight, respectively. CONCLUSION An abnormal IT-ratio was a more common finding than an abnormal WBC in GBS and E. coli EOS. E. coli was significantly associated with prematurity.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria; Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Renoldner B
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Hofer N
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
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Kim JY, Sung JH, Chang KHJ, Choi SJ, Oh SY, Roh CR, Kim JH. Abnormal vaginal colonization by gram-negative bacteria is significantly higher in pregnancy conceived through infertility treatment compared to natural pregnancy. J Matern Fetal Neonatal Med 2016; 30:556-561. [PMID: 27072161 DOI: 10.1080/14767058.2016.1177819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/21/2022]
Abstract
OBJECTIVE To compare abnormal vaginal colonization between natural pregnancy and pregnancy by infertility treatment in high-risk parturient women and to examine the association between abnormal vaginal colonization and early-onset neonatal sepsis (EONS). METHODS The clinical characteristics, vaginal culture result, and delivery outcome of patients who admitted to our high-risk unit between 2005 and 2014 were retrospectively reviewed and compared. We investigated the prevalence of EONS according to maternal vaginal colonization and examined the concordance between maternal vaginal bacteria and etiologic microorganism causing EONS. RESULTS Among 1096 pregnancies, the rate of vaginal colonization by gram-negative bacteria, especially Escherichia coli was significantly higher in pregnancies by infertility treatment after adjustment of confounding variables (E. coli, OR [95% CI]: 2.47 [1.33-4.57], p = 0.004). The rate of EONS was significantly higher in neonates with maternal abnormal vaginal bacteria colonization (OR [95% CI]: 3.38 [1.44-7.93], p = 0.005) after adjusting for confounding variables. Notably, among microorganisms isolated from maternal vagina, E. coli and Staphylococcus aureus were consistent with the results from neonatal blood culture in EONS. CONCLUSIONS Our data implicate a possible association between gram-negative bacteria colonization and infertility treatment and suggest that maternal vaginal colonization may be associated with EONS of neonates in high-risk pregnancy.
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Affiliation(s)
- Ji Y Kim
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Ji-Hee Sung
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Kylie Hae-Jin Chang
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Suk-Joo Choi
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Soo-Young Oh
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Cheong-Rae Roh
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Jong-Hwa Kim
- a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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Jeong H, Han SJ, Yoo HN, Choi SJ, Oh SY, Kim YJ, Roh CR, Kim JH. Comparison of changes in etiologic microorganisms causing early-onset neonatal sepsis between preterm labor and preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2015; 28:1923-8. [PMID: 25283852 DOI: 10.3109/14767058.2014.972928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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 investigate changes in the etiologic microorganisms causing early-onset neonatal sepsis (EONS) in preterm labor (PTL) or preterm premature rupture of membranes (pPROM) cases over the past 16 years and to analyze the associated factors. METHODS We included consecutive singleton pregnancies delivered before 34 weeks due to PTL or pPROM. The etiologic microorganisms causing EONS in PTL and pPROM cases were compared between period 1 (1996-2004) and period 2 (2005-2012). RESULTS There was no difference in the incidence of Gram-positive bacteria causing EONS between period 1 and 2, either in PTL (2.0% versus 2.1%, p = 1.0) or in pPROM (1.5% versus 1.6%, p = 1.0). However, the incidence of EONS caused by Gram-negative bacteria was significantly increased in pPROM (0.6% versus 2.7%, p = 0.040) during period 2, compared to period 1; but not in PTL (0.3% versus 1.2%, p = 0.211). Multivariable analysis revealed that a prolonged ROM-to-delivery interval (>7 d) was significantly associated with EONS caused by Gram-negative bacteria in pPROM (odds ratio: 6.6, 95% confidence interval: 1.4-31.8, p = 0.018). CONCLUSIONS The etiologic microorganisms causing EONS have changed over the past 16 years in pPROM cases but not in PTL cases.
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Affiliation(s)
| | - Su-jin Han
- a Department of Obstetrics and Gynecology and
| | - Ha-Na Yoo
- a Department of Obstetrics and Gynecology and
| | | | | | - Yae-Jean Kim
- b Department of Pediatrics , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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Chiesa C, Pacifico L, Natale F, Hofer N, Osborn JF, Resch B. Fetal and early neonatal interleukin-6 response. Cytokine 2015; 76:1-12. [PMID: 25890877 DOI: 10.1016/j.cyto.2015.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 01/15/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 12/11/2022]
Abstract
In 1998, a systemic fetal cytokine response, defined as a plasma interleukin-6 (IL-6) value above 11 pg/mL, was reported to be a major independent risk factor for the subsequent development of neonatal morbid events even after adjustments for gestational age and other confounders. Since then, the body of literature investigating the use of blood concentrations of IL-6 as a hallmark of the fetal inflammatory response syndrome (FIRS), a diagnostic marker of early-onset neonatal sepsis (EONS) and a risk predictor of white matter injury (WMI), has grown rapidly. In this article, we critically review: IL-6 biological functions; current evidence on the association between IL-6, preterm birth, FIRS and EONS; IL-6 reference intervals and dynamics in the early neonatal period; IL-6 response during the immediate postnatal period and perinatal confounders; accuracy and completeness of IL-6 diagnostic studies for EONS (according to the Standards for Reporting of Diagnostic Accuracy statement); and recent breakthroughs in the association between fetal blood IL-6, EONS, and WMI.
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Affiliation(s)
- Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy.
| | - Lucia Pacifico
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Natale
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy
| | - Nora Hofer
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, AT-8036 Graz, Austria
| | - John F Osborn
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, AT-8036 Graz, Austria
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Giménez M, Sanfeliu I, Sierra M, Dopico E, Juncosa T, Andreu A, Lite J, Guardià C, Sánchez F, Bosch J. [Group B streptococcal early-onset neonatal sepsis in the area of Barcelona (2004-2010). Analysis of missed opportunities for prevention]. Enferm Infecc Microbiol Clin 2014; 33:446-50. [PMID: 25541009 DOI: 10.1016/j.eimc.2014.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/07/2014] [Revised: 08/28/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol. METHODS A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010. RESULTS Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were iii, v, and ia. CONCLUSIONS No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS.
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Affiliation(s)
- Montserrat Giménez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Isabel Sanfeliu
- Servicio de Microbiología, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | | | - Eva Dopico
- Laboratori Clínic de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Juncosa
- Servicio de Microbiología, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Antonia Andreu
- Servicio de Microbiología, Hospital Vall d'Hebron, Barcelona, España
| | - Josep Lite
- Laboratorio de Mirobiología, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - Cèlia Guardià
- Laboratori Barcelonès Nord i Vallès Oriental, Institut Català de la Salut, Badalona, Barcelona, España
| | - Ferran Sánchez
- Servicio de Microbiología, Hospital de Sant Pau, Barcelona, España
| | - Jordi Bosch
- Servicio de Microbiología, Hospital Clínic, Barcelona, España
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