Evolution of perinatal Escherichia coli disease in the era of group B Streptococcus prophylaxis

BACKGROUND: The aim of this study was to characterize perinatal Escherichia coli disease, and to analyze its possible correlation with the employment of prophylaxis for group B streptococcal (GBS) disease. PATIENTS AND METHOD: Between 1994 and 2000, 24 neonates born in our hospita l were diagnosed of early-onset E. coli disease: 12 born to mothers who rec eived prenatal care in our center and 12 born to mothers who were referred from other hospitals shortly before labor. Three further neonates born in o ther centers were also referred with the same diagnosis. RESULTS: The annual rate did not change significantly (RR: 1.065; confidenc e interval [CI] 95% -0.873-1.301; p = 0.533): from 0.6 per 1,000 live birth s in 1994 to 1.7 per 1,000 in 1997 and 0.5 in 2000. Among mothers, 92% pres ented obstetric risk factors including 68% with prematurity (mean 32.9 gest ation weeks, median 32), 64% with prolonged rupture of membranes (mean 184 hours, median 44), and 56% with intrapartum fever. Twelve percent of mother s received intrapartum ampicillin as prophylaxis against GBS and 80% receiv ed antibiotics: prophylaxis for rupture of membranes in 6 cases, treatment of urinary tract infection in 6 cases and treatment of probable chorioamnio nitis in 8 cases. Ampicillin-resistant E. coli was isolated in 81% of neona tes. No significant correlation was found between ampicillin resistance and prematurity (p = 0.57), rupture of membranes (p = 0.63), intrapartum fever (p = 0.24) or death (p = 0.53). CONCLUSIONS: Our results suggest that perinatal E. coli disease is not rela ted with the employment of prophylaxis against GBS disease. Instead, it see ms to be related with prematurity, prolonged gestation in premature rupture of membranes and exposure to antibiotics.