Risk factors and opportunities for prevention of early-onset neonatal sepsis: A multicenter case-control study

Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicab ility of these prevention efforts to infections caused by other organisms i s not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed , early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 li ve births). GBS (1.4 cases per 1000 births) and Escherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-mat ched controls without documented sepsis, GBS disease was associated with in trapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1-8.0). An obstetric risk factor-preterm delivery, intrapartum fever, or membrane rupture greater than or equal to 18 hours-wa s found in 49% of GBS cases and 79% of other sepsis. IAP had an adjusted ef ficacy of 68.2% against any early-onset sepsis. Ampicillin resistance was e vident in 69% of E coli infections. No deaths occurred among susceptible E coli infections, whereas 41% of ampicillin-resistant E coli infections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59% of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could p otentially prevent a substantial portion of GBS cases. Sepsis caused by oth er organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin-resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis.