Associations between maternal bacteremia during the peripartum period and early-onset neonatal sepsis: a retrospective cohort study.
Chorioamnionitis
Infection
Maternal bacteremia
Neonatal bacteremia
Neonatal sepsis
Newborn
Pregnancy
Sepsis
Journal
BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804
Informations de publication
Date de publication:
15 Aug 2024
15 Aug 2024
Historique:
received:
18
10
2023
accepted:
29
07
2024
medline:
15
8
2024
pubmed:
15
8
2024
entrez:
14
8
2024
Statut:
epublish
Résumé
Early-onset neonatal sepsis (EONS) significantly impacts neonatal morbidity and mortality, with maternal bacteremia during the peripartum period being a potential risk factor. This study aims to explore the association between peripartum maternal bacteremia and EONS. A retrospective cohort study at the Women's Wellness and Research Center in Doha, Qatar (2015-2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS. Among the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 - 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 - 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 - 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 - 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 - 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 - 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 - 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 - 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates. This study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.
Identifiants
pubmed: 39143544
doi: 10.1186/s12887-024-04980-z
pii: 10.1186/s12887-024-04980-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
526Informations de copyright
© 2024. The Author(s).
Références
Knowles SJ, O’Sullivan NP, Meenan AM, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG. 2015;122(5):663–71. https://doi.org/10.1111/1471-0528.12892 .
doi: 10.1111/1471-0528.12892
pubmed: 24862293
Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M. Maternal sepsis: a Scottish population-based case-control study. BJOG. 2012;119(4):474–83. https://doi.org/10.1111/j.1471-0528.2011.03239.x .
doi: 10.1111/j.1471-0528.2011.03239.x
pubmed: 22251396
pmcid: 3328752
Kankuri E, Kurki T, Carlson P, Hiilesmaa V. Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand. 2003;82(8):730–5. https://doi.org/10.1034/j.1600-0412.2003.00265.x .
doi: 10.1034/j.1600-0412.2003.00265.x
pubmed: 12848644
Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. 2013;117(4):944–50.
doi: 10.1213/ANE.0b013e3182a009c3
pubmed: 24023020
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.
doi: 10.1016/S2214-109X(14)70227-X
pubmed: 25103301
Weston EJ, Pondo T, Lewis MM, Martell-Cleary P, Morin C, Jewell B, Daily P, Apostol M, Petit S, Farley M, Lynfield R. The burden of invasive early-onset neonatal sepsis in the United States, 2005–2008. Pediatr Infect Dis J. 2011;30(11):937.
doi: 10.1097/INF.0b013e318223bad2
pubmed: 21654548
pmcid: 3193564
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, Bizzarro MJ, Goldberg RN, Frantz ID III, Hale EC, Shankaran S. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;127(5):817–26.
doi: 10.1542/peds.2010-2217
pubmed: 21518717
pmcid: 3081183
Wójkowska-Mach J, Borszewska-Kornacka M, Domańska J, Gadzinowski J, Gulczyńska E, et al. Early-onset infections of very-low-birth-weight infants in Polish neonatal intensive care units. Pediatr Infect Dis J. 2012;31:691–5.
doi: 10.1097/INF.0b013e3182567b74
pubmed: 22466319
Ashwal E, Salman L, Tzur Y, Aviram A, Ben-Mayor Bashi T, Yogev Y, Hiersch L. Intrapartum fever and the risk for perinatal complications - the effect of fever duration and positive cultures. J Matern Fetal Neonatal Med. 2018;31(11):1418–25. https://doi.org/10.1080/14767058.2017.1317740 .
doi: 10.1080/14767058.2017.1317740
pubmed: 28391772
Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, Hudson Jain J, Lynfield R. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics. 2016;138(6).
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018Mar 1;6(3):223–30.
doi: 10.1016/S2213-2600(18)30063-8
pubmed: 29508706
Easter SR, Molina RL, Venkatesh KK, Kaimal A, Tuomala R, Riley LE. Clinical risk factors associated with peripartum maternal bacteremia. Obstet Gynecol. 2017;130(4):710–7.
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128:e1155-1163.
doi: 10.1542/peds.2010-3464
pubmed: 22025590
pmcid: 3208962
Tudela CM, Stewart RD, Roberts SW, Wendel GD Jr, Stafford IA, et al. Intrapartum evidence of early-onset group B streptococcus. Obstet Gynecol. 2012;119:626–9.
doi: 10.1097/AOG.0b013e31824532f6
pubmed: 22353962
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027–35.
doi: 10.1016/S0140-6736(16)31593-8
pubmed: 27839855
pmcid: 5161777
Fan SR, Liu P, Yan SM, Huang L, Liu XP. New concept and management for sepsis in pregnancy and the puerperium. Maternal-Fetal Medicine. 2020;2(04):231–9.
doi: 10.1097/FM9.0000000000000058
American College of Obstetricians and Gynecologists. ACOG Committee Opinion Summary No. 797: prevention of group B streptococcal early-onset disease in newborns. Obstet Gynecol. 2020;135(2):489–92.
Wynn JL, Guthrie SO, Wong HR, Lahni P, Ungaro R, Lopez MC, Baker HV, Moldawer LL. Postnatal age is a critical determinant of the neonatal host response to sepsis. Mol Med. 2015;21(1):496–504.
doi: 10.2119/molmed.2015.00064
pubmed: 26052715
pmcid: 4607623
Wynn JL, Polin RA. A neonatal sequential organ failure assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants. Pediatr Res. 2020;88(1):85–90.
doi: 10.1038/s41390-019-0517-2
pubmed: 31394566
Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100. J Clin Microbiol. 2021;59(12):10–128.
doi: 10.1128/JCM.00213-21
Wilkie GL, Prabhu M, Ona S, Easter SR, Tuomala RE, Riley LE, Diouf K. Microbiology and antibiotic resistance in peripartum bacteremia. Obstet Gynecol. 2019;133(2):269–75.
doi: 10.1097/AOG.0000000000003055
pubmed: 30633127
Blanco JD, Gibbs RS, Castaneda YS. Bacteremia in obstetrics: clinical course. Obstet Gynecol. 1981;58:621–5.
O’Higgins AC, Egan AF, Murphy OC, Fitzpatrick C, Sheehan SR, Turner MJ. A clinical review of maternal bacteremia. Int J Gynaecol Obstet. 2014;124:226–9.
doi: 10.1016/j.ijgo.2013.08.023
pubmed: 24438699
Kankuri E, Kurki T, Carlson P, Hiilesmaa V. Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand. 2003;82:730–5.
doi: 10.1034/j.1600-0412.2003.00265.x
pubmed: 12848644
Valderramos SG, Caughey AB. 14: Neonatal outcomes after maternal sepsis: A population-based cohort study. Am J Obstet Gynecol. 2016;215(6):S820–1.
doi: 10.1016/j.ajog.2016.09.015
Kuhn P, Dheu C, Bolender C, Chognot D, Keller L, Demil H, Donato L, Langer B, Messer J, Astruc D. Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics. Paediatr Perinat Epidemiol. 2010;24(5):479–87.
doi: 10.1111/j.1365-3016.2010.01132.x
pubmed: 20670228
Stoll BJ, Puopolo KM, Hansen NI, Sánchez PJ, Bell EF, Carlo WA, Cotten CM, D’Angio CT, Kazzi SN, Poindexter BB, Van Meurs KP. Early-onset neonatal sepsis 2015 to 2017, the rise of Escherichia coli, and the need for novel prevention strategies. JAMA Pediatr. 2020;174(7):e200593.
doi: 10.1001/jamapediatrics.2020.0593
pubmed: 32364598
pmcid: 7199167
Schuchat A. Group B streptococcus. Lancet. 1999;353(9146):51–6.
doi: 10.1016/S0140-6736(98)07128-1
pubmed: 10023965
Baker CJ, Barrett FF. Transmission of group B streptococci among parturient women and their neonates. J Pediatr. 1973;83(6):919–25.
doi: 10.1016/S0022-3476(73)80524-4
pubmed: 4585831
Puopolo KM, Lynfield R, Cummings JJ, Hand I, Adams-Chapman I, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Mowitz M, Watterberg K. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019;144(2).
Zhu Y, Lin XZ. Updates in prevention policies of early-onset group B streptococcal infection in newborns. Pediatr Neonatol. 2021;62(5):465–75.
doi: 10.1016/j.pedneo.2021.05.007
pubmed: 34099416
Duan R, Xu X, Wang X, Yu H. Perinatal outcome in women with bacterial sepsis: A cross-sectional study from West China. Medicine. 2019;98(44).
Venkatesh KK, Jackson W, Hughes BL, Laughon MM, Thorp JM, Stamilio DM. Association of chorioamnionitis and its duration with neonatal morbidity and mortality. J Perinatol. 2019;39(5):673–82.
doi: 10.1038/s41372-019-0322-0
pubmed: 30723279
Beck C, Gallagher K, Taylor LA, Goldstein JA, Mithal LB, Gernand AD. Chorioamnionitis and risk for maternal and neonatal sepsis: a systematic review and meta-analysis. Obstet Gynecol. 2021;137(6):1007.
doi: 10.1097/AOG.0000000000004377
pubmed: 33957655
pmcid: 8905581
Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatrics Open. 2020;4(1).
Sperling RS, Newton E, Gibbs RS. Intraamniotic infection in low-hirth-weight infants. J Infect Dis. 1988;157(1):113–7.
doi: 10.1093/infdis/157.1.113
pubmed: 3335795
Rallis D, Giapros V, Serbis A, Kosmeri C, Baltogianni M. Fighting Antimicrobial Resistance in Neonatal Intensive Care Units: Rational Use of Antibiotics in Neonatal Sepsis. Antibiotics. 2023;12(3):508.
doi: 10.3390/antibiotics12030508
pubmed: 36978375
pmcid: 10044400