Escherichia coli early-onset sepsis: trends over two decades

Eur J Pediatr. 2017 Sep;176(9):1227-1234. doi: 10.1007/s00431-017-2975-z. Epub 2017 Aug 2.


Escherichia coli early-onset sepsis (EOS) is an important cause of mortality and morbidity in neonates, especially in preterm and very low birth weight (VLBW) newborns. The aim of our study was to evaluate potential changes in the clinical and microbiological characteristics of E. coli EOS in our setting. Epidemiological, clinical, and microbiological data from all neonates with proven E. coli EOS from January 1994 to December 2014 were retrospectively collected in a single tertiary care hospital in Barcelona (Spain). Seventy-eight E. coli EOS cases were analyzed. A slight increase in the incidence of E. coli EOS was observed during the study period. VLBW newborns remained the group with higher incidence (10.4 cases per 1000 live births) and mortality (35.3%). Systematic use of PCR increased E. coli EOS diagnosis, mainly in the term newborn group. There was an increase in resistant E. coli strains causing EOS, with especially high resistance to ampicillin and gentamicin (92.8 and 28.6%, respectively). Nonetheless, resistant strains were not associated with poorer clinical outcomes.

Conclusions: There is an urgent need to reconsider the empirical therapy used in neonatal EOS, particularly in VLBW newborns. What is Known: • E. coli early-onset sepsis (EOS) and E. coli resistant strains have been described as overall stable but increasing in VLBW neonates (< 1.500 g) in previous studies. What is New: • Our study shows an increasing incidence of E. coli EOS in all age groups, overruling group B Streptoccocus for the last 10 years. E. coli resistant strains also increased equally in all age groups, with high resistance rates to our first line antibiotics (ampicillin and gentamicin). • Empiric antibiotic therapy of EOS, mainly in VLBW newborns, should be adapted to this new scenario.

Keywords: Antimicrobial drug resistance; Early-onset neonatal infection; Escherichia coli; Newborn.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Drug Resistance, Bacterial*
  • Escherichia coli / drug effects*
  • Escherichia coli / isolation & purification
  • Escherichia coli Infections / blood
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / epidemiology
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Infant, Extremely Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Neonatal Sepsis / blood
  • Neonatal Sepsis / drug therapy*
  • Neonatal Sepsis / epidemiology*
  • Polymerase Chain Reaction
  • Retrospective Studies
  • Spain / epidemiology
  • Young Adult


  • Anti-Bacterial Agents