BACKGROUND: Group B Streptococcus (GBS) and Escherichia coli have historically dominated as causes of early-onset neonatal sepsis. Widespread use of intrapartum prophylaxis for GBS disease led to concerns about the potential adverse impact on E coli incidence.METHODS: Active, laboratory, and population-based surveillance for culture-positive (blood or cerebrospinal fluid) bacterial infections among infants 0 to 2 days of age was conducted statewide in Minnesota and Connecticut and in selected counties of California and Georgia during 2005 to 2014. Demographic and clinical information were collected and hospital live birth denominators were used to calculate incidence rates (per 1000 live births). We used the Cochran–Amitage test to assess trends.RESULTS: Surveillance identified 1484 cases. GBS was most common (532) followed by E coli (368) and viridans streptococci (280). Eleven percent of cases died and 6.3% of survivors had sequelae at discharge. All-cause (2005: 0.79; 2014: 0.77; P = .05) and E coli (2005: 0.21; 2014: 0.18; P = .25) sepsis incidence were stable. GBS incidence decreased (2005: 0.27; 2014: 0.22; P = .02). Among infants 1500 g, incidence was an order of magnitude higher for both pathogens and stable. The odds of death among infants 1500 g were similar for both pathogens but among infants ≥1500 g, the odds of death were greater for E coli cases (odds ratio: 7.0; 95% confidence interval: 2.7–18.2).CONCLUSIONS: GBS prevention efforts have not led to an increasing burden of early-onset E coli infections. However, the stable burden of E coli sepsis and associated mortality underscore the need for interventions.
展开▼
机译：背景：B组链球菌（GBS）和大肠杆菌在历史上一直占主导地位，是引起早发新生儿败血症的原因。广泛使用产前预防GBS疾病引起人们对大肠杆菌发病率的潜在不利影响的担忧。方法：积极，实验室和基于人群的监测婴儿0到2天的培养阳性（血液或脑脊髓液）细菌感染的方法在2005年至2014年期间，在明尼苏达州和康涅狄格州以及部分加利福尼亚州和乔治亚州的全州范围内进行年龄统计。收集了人口统计学和临床信息，并使用医院活产婴儿分母计算发病率（每1000活产婴儿）。我们使用Cochran-Amitage检验来评估趋势。结果：监测发现1484例。 GBS是最常见的（532），其次是大肠杆菌（368）和绿色的链球菌（280）。出院后有11％的病例死亡，6.3％的幸存者有后遗症。全因（2005：0.79; 2014：0.77; P = 0.05）和大肠杆菌（2005：0.21; 2014：0.18; P = 0.25）败血症发生率稳定。 GBS发生率下降（2005：0.27; 2014：0.22; P = .02）。在<1500 g的婴儿中，两种病原体的发病率都较高，而且稳定。两种病原体在<1500 g的婴儿中死亡几率相似，但在≥1500 g的婴儿中，大肠杆菌病例的死亡几率更高（优势比：7.0; 95％置信区间：2.7-18.2）。预防工作并未导致早发性大肠杆菌感染的负担增加。但是，大肠杆菌败血症的稳定负担和相关死亡率强调了干预的必要性。
展开▼
