Nationwide epidemiology of early-onset sepsis in Israel 2010-2015, time to re-evaluate empiric treatment.

Anti-Bacterial Agents / therapeutic use Drug Resistance, Microbial Humans Infant, Newborn Infant, Premature Israel / epidemiology Neonatal Sepsis / drug therapy

Antimicrobial resistance rates Early-onset neonatal sepsis Empiric antimicrobial therapy Gram-negative pathogens Preterm neonates

Journal

Acta paediatrica (Oslo, Norway : 1992)

ISSN: 1651-2227

Titre abrégé: Acta Paediatr

Pays: Norway

ID NLM: 9205968

Informations de publication

Date de publication:
12 2019

Historique:

received: 13 03 2019

revised: 27 05 2019

accepted: 04 06 2019

pubmed: 7 6 2019

medline: 30 10 2020

entrez: 7 6 2019

Statut: ppublish

Résumé

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. A retrospective, nationwide cohort study analysing 2010-2015 EOS data in Israel. 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]. 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.

Identifiants

DOI: 10.1111/apa.14889 PMID: 31168848

pubmed: 31168848

doi: 10.1111/apa.14889

doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

2192-2198

Investigateurs

Michal Stein (M)

Daniel Glikman (D)

Nitzan Curiel (N)

Aharona Glatman-Freedman (A)

Orli Megged (O)

Smadar Eventov-Fiedman (S)

Natan Keller (N)

Or Kriger (O)

Eli Somekh (E)

Dana Tasher (D)

Giora Gottesman (G)

Alex Guri (A)

Liat Ashkenazi-Hoffnung (L)

Haim Ben-Zvi (H)

Ilan Youngster (I)

Jacky Herzlich (J)

Yehudit Schindler (Y)

Ronella Marom (R)

Uri Rubinstein (U)

Eyas Midlij (E)

Dan Miron (D)

Rana Damouni (R)

Imad Kassis (I)

Nili Nimri-Atrash (N)

Sarit Freiman (S)

Karen Lavie (K)

Tatiana Smolkin (T)

Rimma Melamed (R)

Mara Troitzky (M)

Avi Sayag (A)

Informations de copyright

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