Background. The widespread use of intrapartum antibiotics (IPA) has raised concerns regarding the adverse effects on the newborn. Objectives. To determine if IPA is associated with infantile late-onset serious bacterial infections (SBIs) and with antibiotic resistance. Patients and methods. From 2005 to 2009, data were prospectively collected for all infants born at our center, aged 7 to 90 days, who were hospitalized for fever. Cases included infants with culture-proven SBIs, and controls included infants without SBIs. Results. A total of 71 cases and 124 controls were included. IPA was documented in 11.3% of cases and in 7.3% of controls (P = .34). Among cases, ampicillin resistance was documented in 85% of antibiotic-exposed infants and in 63% of nonexposed infants (P = .19). Corresponding rates for first-generation cephalosporin resistance in urinary tract infection were 75% and 23.5% (P = .04). Conclusion. IPA is associated with a trend toward increased antibiotic resistance in late-onset SBIs. This should be taken into consideration in the selection of empirical therapy for febrile infants.
Schrag SJ, Zell ER, Lynfield R., et al. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med. 2002;347:233-239.
2.
CDC.Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR Morb Mortal Wkly Rep. 2002;51:1-22.
3.
American College of Obstetricians and Gynecologists, Committee on Obstetrics Practice.Prevention of Early-Onset Group B Streptococcal Disease in Newborns [opinion 279]. Washington, DC: American College of Obstetricians and Gynecologists ; 2002.
4.
Smaill F.Intrapartum antibiotics for group B streptococcal colonisation. Cochrane Database Syst Rev.2000;(2): CD000115.
5.
Trends in perinatal group B streptococcal disease: United States, 2000-2006. MMWR Morb Mortal Wkly Rep. 2009 ; 58:109.
6.
Hyde TB, Hilger TM, Reingold A., Farley MM, O’Brien KL, Schuchat A.Active Bacterial Core Surveillance (ABCS) of the Emerging Infections Program Network: trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta. Pediatrics. 2002;110:690-695.
7.
Alarcon A., Peña P., Salas S., Sancha M., Omeñaca F.Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis . Pediatr Infect Dis J. 2004;23:295-299.
8.
Towers CV, Carr MH, Padilla G., Asrat T.Potential consequences of widespread antepartal use of ampicillin . Am J Obstet Gynecol. 1998;179:879-883.
9.
Towers CV, Briggs GGAntepartum use of antibiotics and early-onset neonatal sepsis: the next 4 years. Am J Obstet Gynecol. 2002;187:495-500.
10.
Stoll BJ, Hansen N., Fanaroff AA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002;347:240-247.
11.
Moore MR, Schrag SJ, Schuchat A.Effects of intrapartum antimicrobial prophylaxis for prevention of group-B-streptococcal disease on the incidence and ecology of early-onset neonatal sepsis. Lancet Infect Dis. 2003 ;3:201-213.
12.
Shah SS, Ehrenkranz RA, Gallagher PGIncreasing incidence of gram-negative rod bacteremia in a newborn intensive care unit. Pediatr Infect Dis J. 1999;18:591-595.
13.
Terrone DA, Rinehart BK, Einstein MH, Britt LB, Martin JN Jr, Perry KGNeonatal sepsis and death caused by resistant Escherichia coli: possible consequences of extended maternal ampicillin administration. Am J Obstet Gynecol. 1999;180(6,pt1):1345-1348.
Bizzarro MJChanging patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics . 2008;121:689-696.
16.
Kafulafula G. , Mwatha A., Chen YQ, et al. Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa . Pediatrics . 2009;124:e137-e144.
17.
Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P., Reingold A., Schuchat A.Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics . 2006;118:570.
18.
Sutkin G., Krohn MA, Heine RP, Sweet RLAntibiotic prophylaxis and non-group B streptococcal neonatal sepsis . Obstet Gynecol. 2005;105:581-586.
19.
Chen KT, Puopolo KM, Eichenwald EC, Onderdonk AB, Leiberman E.No increase in rates of early-onset neonatal sepsis by antibiotic-resistant group B Streptococcus in the era of intrapartum antibiotic prophylaxis. Am J Obstet Gynecol. 2005;192:1167-1171.
20.
Rentz AC, Samore MH, Stoddard GJ, Faix RG, Byington CLRisk factors associated with ampicillin-resistant infection in newborns in the era of group B streptococcal prophylaxis. Arch Pediatr Adolesc Med. 2004;158:556-560.
21.
Sinha A., Yokoe D., Platt R.Intrapartum antibiotics and neonatal invasive infections caused by organisms other than group B Streptococcus. J Pediatr. 2003;142:492-497.
22.
Baltimore RS , Huie SM, Meek JI, Schuchat A., O’Brien KLEarly-onset neonatal sepsis in the era of group B streptococcal prevention. Pediatrics. 2001;108:1094-1098.
23.
Glasgow TS, Young PC, Wallin J., et al. Association of intrapartum antibiotic exposure and late-onset serious bacterial infections in infants. Pediatrics. 2005;116: 696-702.
24.
Mercer BM, Carr TL, Beazley DD, Crowe DT, Sibai BMAntibiotic use in pregnancy and drug-resistant infant sepsis. Am J Obstet Gynecol. 1999;181:816-821.
25.
Committee on Quality Improvement.Subcommittee on Urinary Tract Infections. Practice parameter: the diagnosis, treatment, and evaluation of the initial UTI in febrile infants and young children. Pediatrics. 1999;103:843-852.
26.
National Committee of Clinical Laboratory Standards (NCCLS).M7-A45: Methods for dilution and antimicrobial susceptibility testing for bacteria that grow aerobically;2000. www.clsi.org
27.
National Committee of Clinical Laboratory Standards (NCCLS).M2-A7: Performance for antimicrobial disk-susceptibility testing: approved standard; 2000. www.clsi.org
28.
McNanley AR , Glantz JC, Hardy DJ, Vicino D.The effect of intrapartum penicillin on vaginal group B Streptococcus colony counts. Am J Obstet Gynecol. 2007;197:583, e1-e4.
29.
Mackie RI, Sghir A., Gaskins HRDevelopmental microbial ecology of the neonatal gastrointestinal tract . Am J Clin Nutr. 1999;69:1035S-1045S.
30.
Brunel A., Gouet P.Influence of the destabilisation of the maternal digestive microflora on that of the newborn rat. Biol Neonate. 1993;63:236-245.
31.
Tullus K., Berglund B., Burman LGEmergence of cross-resistance to beta-lactam antibiotics in fecal Escherichia coli and Klebsiella strains from neonates treated with ampicillin or cefuroxime . Antimicrob Agents Chemother. 1990;34:361-362.
32.
Tullus K., Burman LGEcological impact of ampicillin and cefuroxime in neonatal units. Lancet. 1989;2:509-510.
