Intrapartum antibiotic prophylaxis and early-onset neonatal sepsis patterns

Infect Dis Obstet Gynecol. 2003;11(4):221-6. doi: 10.1080/10647440300025525.

Abstract

Objective: To compare the relative effects of intrapartum antibiotic prophylaxis regimens on patterns of early-onset neonatal sepsis.

Methods: We performed an historical cohort study of 17187 infants born at our center from September 1993 to February 2000. A risk-based strategy was employed prior to July 1996 and a screening-based strategy was utilized thereafter. Ampicillin was utilized prior to March 1995 and penicillin was used thereafter.

Results: There were 75 cases of neonatal sepsis, 34 (4. 10/1000) in the risk-based era and 41 (4.63/1000) in the screening-based era (p = 0.62). There were fewer ampicillin-resistant isolates during the risk-based than the screening-based era (32 versus 61%; p = 0.014). The only significant change in organism-specific sepsis rates was an increase in the rate of infection caused by coagulase-negative staphylococci in the screening-based era (0.36 versus 1.46/1000; p = 0.018), but 75% of infants infected with these organisms were not exposed to beta-lactam antibiotics within 72 h prior to delivery. For the risk- and screening-based eras, respectively, the rates of Gram-negative sepsis (1.21 versus 1.46/1000; p = 0.65) and the proportions of Gram-negative pathogens that were ampicillin-resistant (70 versus 77%; p = 1.0) were similar. The drug employed for prophylaxis did not appear to affect the pattern of sepsis cases.

Conclusion: In our patient population, coagulase-negative staphylococci have become the most common cause of early-onset neonatal sepsis. The cause of this shift in pathogen prevalence is uncertain and seemingly unrelated to intrapartum antibiotic exposure.

Publication types

  • Comparative Study

MeSH terms

  • Ampicillin / therapeutic use*
  • Antibiotic Prophylaxis*
  • Bacteremia / epidemiology
  • Bacteremia / prevention & control*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology
  • Infant, Newborn, Diseases / prevention & control
  • Infectious Disease Transmission, Vertical / prevention & control
  • Male
  • Pregnancy
  • Pregnancy Complications, Infectious / microbiology
  • Pregnancy Complications, Infectious / prevention & control*
  • Pregnancy Outcome
  • Prevalence
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / prevention & control*
  • Streptococcal Infections / transmission
  • Streptococcus agalactiae / drug effects*

Substances

  • Ampicillin