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Berardi A, Spada C, Vaccina E, Boncompagni A, Bedetti L, Lucaccioni L. Intrapartum beta-lactam antibiotics for preventing group B streptococcal early-onset disease: can we abandon the concept of 'inadequate' intrapartum antibiotic prophylaxis? Expert Rev Anti Infect Ther 2019; 18:37-46. [PMID: 31762370 DOI: 10.1080/14787210.2020.1697233] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Neonatal sepsis remains a serious and potentially fatal illness. Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcal (GBS) early-onset sepsis. The optimal duration of IAP (adequate IAP) to reduce vertical transmission of GBS has been debated. Understanding the mechanism of action of IAP may help in minimizing neonatal evaluation and unnecessary antibiotic use.Areas covered: In recent years, several studies on pharmacokinetics and clinical use of IAP have been published. Although penicillin and ampicillin are the most preferred antibiotics, the clinical efficacy of non-beta-lactam antibiotics, including clindamycin and vancomycin, used in cases of penicillin anaphylaxis-associated allergy, remains debatable. This is a narrative review of the literature regarding the impact of 'inadequate' IAP on the clinical management of women and newborns.Expert opinion: Recent evidence suggests that 'inadequate' IAP with beta-lactams is more effective in preventing vertical transmission of GBS than previously thought. Newborns exposed to intrapartum beta-lactams and who are asymptomatic at birth are likely uninfected, irrespective of IAP duration before delivery. Hence, we may abandon the concept of 'inadequate' IAP with beta-lactams in early-onset GBS sepsis, relying primarily on clinical signs observed at birth for managing IAP-exposed neonates.
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Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Spada
- Pediatric Post-graduate School, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Vaccina
- Pediatric Post-graduate School, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luca Bedetti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera, University of Modena and Reggio Emilia, Modena, Italy
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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.
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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
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