1
|
Dong X, Chen X, Xue M, Zhang Y. Changes in serum inflammatory factors in group B streptococcal infection and their predictive value for premature rupture of membranes complicated by chorioamnionitis. Biomark Med 2024. [PMID: 38623925 DOI: 10.2217/bmm-2023-0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Objective: The aim of this study as to unveil changes in serum inflammatory factors in pregnant women with genital tract group B Streptococcus (GBS) infection and their predictive value for premature rupture of membranes (PROM) complicated by chorioamnionitis (CS) and adverse pregnancy outcomes. Methods: The value of serum inflammatory factor levels in predicting PROM complicating CS and adverse pregnancy outcomes in GBS-infected pregnant women was evaluated by ELISA. Results: Serum IL-6, TNF-α, PCT and hs-CRP levels were higher in pregnant women with GBS infection. The combined diagnosis of these factors had excellent diagnostic value in PROM complicating CS and adverse pregnancy outcomes. Conclusion: Joint prediction of IL-6, TNF-α, PCT and hs-CRP has the best predictive value for PROM complicating CS and adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Xiaorui Dong
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, 310000, China
| | - Xixi Chen
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, 310000, China
| | - Mengling Xue
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, 310000, China
| | - Yina Zhang
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, 310000, China
| |
Collapse
|
2
|
Snoek L, Karampatsas K, Bijlsma MW, Henneke P, Jauneikaite E, Khan UB, Zadoks RN, Le Doare K. Meeting report: Towards better risk stratification, prevention and therapy of invasive GBS disease, ESPID research meeting May 2022. Vaccine 2023; 41:6137-6142. [PMID: 37699783 DOI: 10.1016/j.vaccine.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/14/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
The European Society of Pediatric Infectious Diseases (ESPID) hosted the third Group B Streptococcus (GBS) Research Session in Athens on 11th May 2022, providing researchers and clinicians from around the world an opportunity to share and discuss recent advances in GBS pathophysiology, molecular and genetic epidemiology and how these new insights can help in improving prevention and control of early- and late-onset GBS disease. The meeting provided a state-of-the-art overview of the existing GBS prevention strategies and their limitations, and an opportunity to share the latest research findings. The first presentation provided an overview of current GBS prevention and treatment strategies. In the second presentation, the genomic and antimicrobial resistance profiles of invasive and colonizing GBS strains were presented. The third presentation explained the association of intrapartum antibiotic prophylaxis (IAP) with the development of late-onset disease (LOD) and the interplay of host innate immunity and GBS. The fourth presentation evaluated the role of genomics in understanding horizontal GBS transmission. The fifth presentation focused on the zoonotic links for certain GBS lineages and the last presentation described the protective role of breastmilk. Talks were followed with interactive discussions and concluded with recommendations on what is needed to further GBS clinical research; these included: (i) the development of better risk stratification methods by combining GBS virulence factors, serological biomarkers and clinical risk factors; (ii) further studies on the interplay of perinatal antimicrobials, disturbances in the development of host immunity and late-onset GBS disease; (iii) routine submission of GBS isolates to reference laboratories to help in detecting potential clusters by using genomic sequencing; (iv) collaboration in animal and human GBS studies to detect and prevent the emergence of new pathogenic sequence types; and (v) harnessing the plethora of immune factors in the breastmilk to develop adjunct therapies.
Collapse
Affiliation(s)
- Linde Snoek
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands.
| | - Konstantinos Karampatsas
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Merijn W Bijlsma
- Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Philipp Henneke
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), University Medical Center and Faculty of Medicine, Freiburg, Germany; Institute for Infection Prevention and Control, University Medical Center and Faculty of Medicine, Freiburg, Germany
| | - Elita Jauneikaite
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Uzma B Khan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom; Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Ruth N Zadoks
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| |
Collapse
|
3
|
Steflik HJ, Charlton JR, Briley M, Selewski DT, Gist KM, Hanna MH, Askenazi D, Griffin R. Neonatal nephrotoxic medication exposure and early acute kidney injury: results from the AWAKEN study. J Perinatol 2023; 43:1029-1037. [PMID: 37100984 PMCID: PMC10725773 DOI: 10.1038/s41372-023-01684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND We aimed to describe nephrotoxic medication exposure and investigate associations between exposure and acute kidney injury (AKI) in the neonatal intensive care unit during the first postnatal week. DESIGN/METHODS Secondary analysis of the AWAKEN cohort. We evaluated nephrotoxic medication exposure during the first postnatal week and associations with AKI using time-varying Cox proportional hazard regressions models. Nephrotoxic medication exposure categories were defined as: no nephrotoxic medication, nephrotoxic medications excluding aminoglycosides, aminoglycoside alone, and aminoglycoside and another nephrotoxic medication. RESULTS Of 2162 neonates, 1616 (74.7%) received ≥1 nephrotoxic medication. Aminoglycoside receipt was most common (72%). AKI developed in 211(9.8%) neonates and was associated with a nephrotoxic medication exposure (p < 0.01). Nephrotoxic medication exposures including a nephrotoxic medication excluding aminoglycoside (aHR 3.14, 95% CI 1.31-7.55) and aminoglycoside and another nephrotoxic medication (aHR 4.79, 95% CI 2.19-10.50) were independently associated with AKI and severe AKI (stage 2/3), respectively. CONCLUSIONS Nephrotoxic medication exposure in critically ill infants is common during the first postnatal week. Specific nephrotoxic medication exposure, principally aminoglycosides with another nephrotoxic medication, are independently associated with early AKI.
Collapse
Affiliation(s)
- Heidi J Steflik
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Meagan Briley
- Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Katja M Gist
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - David Askenazi
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
4
|
Lukanović D, Batkoska M, Kavšek G, Druškovič M. Clinical chorioamnionitis: where do we stand now? Front Med (Lausanne) 2023; 10:1191254. [PMID: 37293298 PMCID: PMC10244675 DOI: 10.3389/fmed.2023.1191254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
Intraamniotic infection is an infection resulting in the inflammation of any combination of the amniotic fluid, the placenta, the fetus itself, the fetal membranes, umbilical cord, or the decidua. In the past, an infection of the amnion and chorion or both was dubbed chorioamnionitis. In 2015, a proposal was made by an expert panel that, instead of clinical chorioamnionitis, the name intrauterine inflammation or infection or both be used, abbreviated as Triple I or simply IAI. However, the abbreviation IAI did not gain popularity, and this article uses the term chorioamnionitis. Chorioamnionitis may arise prior to, during, or following labor. It can present as a chronic, subacute, or acute infection. Its clinical presentation is generally referred to as acute chorioamnionitis. The treatment of chorioamnionitis varies widely across the world due to different bacterial causes and the absence of sufficient evidence to support a specific treatment regimen. There are limited randomized controlled trials that have evaluated the superiority of antibiotic regimens for treating amniotic infections during labor. This lack of evidence-based treatment suggests that the current choice of antibiotics is based on limitations in existing research, rather than absolute science. Chorioamnionitis cannot be cured by antibiotic therapy alone without delivery, and therefore it is necessary to make a decision according to the guidelines for induction of labor or acceleration of delivery. When a diagnosis is suspected or established, it is therefore necessary to apply broad-spectrum antibiotics according to the protocol used by each country, and to continue with them until delivery. A commonly recommended first-line treatment for chorioamnionitis is a simple regimen consisting of amoxicillin or ampicillin and once-daily gentamicin. Available information is not sufficient to indicate the best antimicrobial regimen to treat this obstetric condition. However, the evidence that is currently available suggests that patients with clinical chorioamnionitis, primarily women with a gestational age of 34 weeks or more and those in labor, should receive treatment with this regime. However, antibiotic preferences may vary based on local policy, clinician experience and knowledge, bacterial reasons for the infection, antimicrobial resistance patterns, maternal allergies, and drug availability.
Collapse
Affiliation(s)
- David Lukanović
- Division of Obstetrics and Gynecology, Ljubljana University Medical Center, Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marija Batkoska
- Division of Obstetrics and Gynecology, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Gorazd Kavšek
- Division of Obstetrics and Gynecology, Department of Perinatology, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Mirjam Druškovič
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Division of Obstetrics and Gynecology, Department of Perinatology, Ljubljana University Medical Center, Ljubljana, Slovenia
| |
Collapse
|
5
|
Radzinsky VE, Doronina OK, Olenev AS, Stetsyuk OV. Group B streptococcus in obstetrics: unsolved problems. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-9-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
For several decades, among all possible pathogens of neonatal infections, group B streptococcus has been one of the leading positions. Sepsis, meningitis, and pneumonia are among the most common clinical manifestations of neonatal infection associated with group B streptococcus. In this review, our goal was to analyze the literature demonstrating a worldwide approach to the prevention of vertical transmission of group B streptococcus from mother to child. When writing the review, scientific publications of foreign and domestic authors from the PubMed database were studied. The review considers the drugs of choice for intranatal antibiotic prophylaxis, and their pharmacodynamic, and pharmacokinetic features. The analysis details the problem of the growth of resistance of group B streptococcus to antibacterial drugs. The antimicrobial activity of lactoferrin was noted at a minimum inhibitory concentration of 500 μg/ml. The presented review also reflects the protective and therapeutic effects of oral intake of probiotics containing Lactobacillus acidophilus, Lactobacillus salivarius, Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14 . Based on the analysis, it can be concluded that penicillin G and ampicillin have the most pronounced bactericidal effect against group B streptococcus. At the same time, the most common side effects of β-lactam penicillins include an allergic reaction with the possible development of anaphylactic shock. Given this, the antibiotics of the first-line reserve group include cefazolin, clindamycin, and vancomycin. At the same time, it is important to take into account the decrease in the therapeutic concentration of clindamycin with a change in the alpha-1-acid glycoprotein in the blood of the mother and fetus, the nephrotoxic effect of vancomycin and the cross-a llergic reaction of cefazolin with antibiotics of the penicillin group. A promising direction in solving the problem of group B streptococcus is the development of new strategies for the prevention of perinatal infection of the fetus and newborn based on a more detailed study of the effects of lactoferrin and probiotics.
Collapse
|
6
|
Choi Y, Han HS, Chong GO, Le TM, Nguyen HDT, Lee OEM, Lee D, Seong WJ, Seo I, Cha HH. Updates on Group B Streptococcus Infection in the Field of Obstetrics and Gynecology. Microorganisms 2022; 10:microorganisms10122398. [PMID: 36557651 PMCID: PMC9780959 DOI: 10.3390/microorganisms10122398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a Gram-positive bacterium that is commonly found in the gastrointestinal and urogenital tracts. However, its colonization during pregnancy is an important cause of maternal and neonatal morbidity and mortality worldwide. Herein, we specifically looked at GBS in relation to the field of Obstetrics (OB) along with the field of Gynecology (GY). In this review, based on the clinical significance of GBS in the field of OBGY, topics of how GBS is being detected, treated, and should be prevented are addressed.
Collapse
Affiliation(s)
- Yeseul Choi
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hyung-Soo Han
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
| | - Gun Oh Chong
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Tan Minh Le
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hong Duc Thi Nguyen
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Olive EM Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Donghyeon Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Incheol Seo
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| |
Collapse
|
7
|
An H, Zheng W, Zhu Q, Chai Y. A retrospective study of risk factors for early-onset neonatal sepsis with intrapartum maternal fever. PeerJ 2022; 10:e13834. [PMID: 35979478 PMCID: PMC9377330 DOI: 10.7717/peerj.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023] Open
Abstract
Background Intrapartum fever is a well-known risk factor for adverse perinatal outcomes. In this study, we evaluated the clinical features for intrapartum maternal fever and investigated the risk factors for neonatal early-onset sepsis (EOS) with intrapartum maternal fever. Methods This retrospective cohort study involved a total of 568 neonates born to mothers with intrapartum maternal fever (temperature peak ≥38 degree Celsius) in Hangzhou Women's Hospital from January 1st to December 31st, 2019. Neonates were assigned to the EOS and non-sepsis groups based on the diagnostic criteria for early-onset neonatal sepsis,. Demographic data, clinical information and laboratory test results were evaluated to assess the risk factors for EOS. Results A total of 568 neonates were included in this study, 84 of whom were diagnosed with EOS. The EOS group was significantly different from the non-sepsis group in 11 items including the both white blood cell (WBC) count and C-reactive protein (CRP) level of the mother before delivery (p < 0.05). A logistic regression analysis revealed that a high maternal WBC count before delivery (OR = 3.261, p = 0.019) and a maternal histological chorioamnionitis (HCA) diagnosis (OR = 5.608, p = 0.002) were independent risk factors for EOS. The optimal cut-off value for WBC (before delivery) was 16.75 × 10*9/L for EOS, according to receiver operating characteristic analysis (area under curve was 0.821). Conclusions Elevated prenatal maternal WBC counts and maternal HCA diagnosis are both independently associated with EOS. Prenatal maternal WBC counts can be used as a sensitive indicator to predict EOS early.
Collapse
Affiliation(s)
- Hongmin An
- Obstetrics Department, Hangzhou Women’s Hospital, Hangzhou, China
| | - Wei Zheng
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qinghua Zhu
- Obstetrics Department, Hangzhou Women’s Hospital, Hangzhou, China
| | - Yun Chai
- Obstetrics Department, Hangzhou Women’s Hospital, Hangzhou, China
| |
Collapse
|
8
|
Reducing Antibiotic Use in a Level III and Two Level II Neonatal Intensive Care Units Targeting Prescribing Practices for Both Early and Late-onset Sepsis: A Quality Improvement Project. Pediatr Qual Saf 2022; 7:e555. [PMID: 35720871 PMCID: PMC9197376 DOI: 10.1097/pq9.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: Variation in antibiotic (ATB) use exists between neonatal intensive care units (NICUs) without demonstrated benefit to outcomes tested. Studies show that early-onset sepsis occurs in up to 2% of NICU patients, yet antibiotics (ABX) were started in over 50% of neonates admitted to our NICUs. An internal audit identified variations in prescribing practices and excessive use of ABX. As a result, we introduced ATB stewardship to our NICUs in 2015 to reduce unnecessary usage of these medications. Methods: We used standard quality improvement methodology utilizing multiple iterative plan-do-study-act cycles during a 6-year project to test various interventions aimed at using ABX wisely. Specifically, our goals were to reduce ABX on admission (AA), percent of patients who continued on ABX beyond 72 hours of life (AC), and ATB utilization rate in our 3 NICUs by 28% for each metric. Interventions implemented included the development of an ATB stewardship program consisting of a multidisciplinary team that met regularly, creation of tools and guidelines for evaluations of sepsis and ATB use, universal use of the neonatal early-onset sepsis calculator for all newborns 34 weeks and older gestational age, education regarding noninitiation of ABX for maternal indications in clinically well newborns, and discontinuation within 48 hours for asymptomatic newborns with negative blood cultures. Results: AA, AC, and ATB utilization rate decreased by 34.1%, 45.3%, and 34.9%, respectively, in our 3 NICUs. Conclusions: By introducing ATB stewardship in our NICUs, we exceeded our predetermined goal of significantly reducing ATB usage.
Collapse
|
9
|
Duffy CR, Huang Y, Andrikopoulou M, Stern-Ascher CN, Wright JD, D'Alton ME, Friedman AM. Vancomycin during delivery hospitalizations for women with group B streptococcus. J Matern Fetal Neonatal Med 2022; 35:898-906. [PMID: 32160789 PMCID: PMC7757725 DOI: 10.1080/14767058.2020.1733520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Vancomycin use for intrapartum GBS prophylaxis is not well characterized. The objective of this study was to describe trends in the use of vancomycin among women undergoing vaginal delivery with group B Streptococcus (GBS) colonization. METHODS An administrative inpatient database that includes medications was analyzed to evaluate antibiotic use in women undergoing vaginal delivery hospitalizations complicated by GBS colonization from January 2006 to March 2015. Patients with other obstetric or infectious indications for antibiotics were excluded. Frequency of use of individual antibiotic agents was determined. The Cochran-Armitage test was used to assess temporal trends. An adjusted log-linear regression model accounting for demographic and hospital factors with vancomycin receipt as the outcome was performed with adjusted risk ratios (aRR) and 95% confidence intervals (CI) as the measure of effect. Hospital level variation in administration of vancomycin was also evaluated. RESULTS 469,717 deliveries met inclusion criteria and were included in this analysis. Use of vancomycin increased from 0.8% of patients in 2006 to 3.8% of patients in the first quarter of 2015. Comparing 2015 to 2006 both the unadjusted (relative risk 4.89 95% CI 4.26-5.60) and adjusted (aRR 4.52 95% 3.94-5.19) models demonstrated significantly increased likelihood of vancomycin administration. In evaluating hospital level vancomycin use, variation was noted with 8.0% of centers administering vancomycin to ≥6.0% of patients. CONCLUSIONS Vancomycin is becoming increasingly commonly used for intrapartum GBS prophylaxis. Further research and quality improvements initiatives are indicated to optimize intrapartum GBS antibiotic prophylaxis.
Collapse
Affiliation(s)
- Cassandra R Duffy
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yongmei Huang
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maria Andrikopoulou
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Conrad N Stern-Ascher
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jason D Wright
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary E D'Alton
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alexander M Friedman
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
10
|
Normal Pregnancy, Labor, and Delivery. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
Fister P, Peček J, Jeverica S, Primec ZR, Paro-Panjan D. Neonatal Group B Streptococcal Meningitis: Predictors for Poor Neurologic Outcome at 18 Months. J Child Neurol 2022; 37:64-72. [PMID: 34816748 DOI: 10.1177/08830738211053128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To find early predictors for poor neurodevelopmental outcome after neonatal group B streptococcal meningitis. METHODS We retrospectively analyzed clinical characteristics of 23 patients with neonatal group B streptococcal meningitis and their neurodevelopmental outcome at 18 months. Available group B Streptococcus strains were serotyped and their genomes characterized. RESULTS We found several differences between patients with early- (n = 5) and late-onset (n = 18) disease. Nine children had neurologic abnormalities at 18 months and 4 had epilepsy, all of them after late-onset disease. Most important risk factors for poor outcome were impaired consciousness at admission, hemodynamic instability, seizures, or abnormal electroencephalogram during the acute illness and abnormal neurologic and ophthalmologic examination at the end of treatment, whereas abnormalities in laboratory and imaging studies were not predictive. Hypervirulent serotype III, multilocus sequence type 17 group B Streptococcus was the predominant pathogen. CONCLUSIONS Neurodevelopmental impairment after neonatal group B streptococcal meningitis is likelier in those with clinical and neurophysiological features indicating worse disease severity.
Collapse
Affiliation(s)
- Petja Fister
- Department of Neonatology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,37664Faculty of Medicine, University of Ljubljana, Slovenia
| | - Jerneja Peček
- Department of Neonatology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,37664Faculty of Medicine, University of Ljubljana, Slovenia
| | - Samo Jeverica
- 68924National Laboratory for Health, Environment and Food, Maribor, Slovenia
| | - Zvonka Rener Primec
- 37664Faculty of Medicine, University of Ljubljana, Slovenia.,Department of Neurology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Darja Paro-Panjan
- Department of Neonatology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,37664Faculty of Medicine, University of Ljubljana, Slovenia
| |
Collapse
|
12
|
Salas Garcia S, Valcarcel Ruescas B, Aristoy Zabaleta M, León García S, Parra-Llorca A, Toledo JD. Early-onset sepsis: a cohort study comparing serial clinical observation with laboratory testing. J Perinatol 2021; 41:2482-2487. [PMID: 34239042 DOI: 10.1038/s41372-021-01138-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/24/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Early onset sepsis (EOS) remains a serious and potentially fatal illness. We aimed to demonstrate that serial clinical observation (SCO) is a feasible strategy associated with fewer laboratory evaluations and unnecessary antibiotic use. STUDY DESIGN We compared the admissions and antibiotic therapy in neonates ≥35 weeks' gestation at risk for EOS in a prospective cohort after the implementation of a new protocol based on SCO (n = 381) with a historical cohort which received laboratory testing (n = 417). RESULTS There was a significant reduction in admissions for suspected sepsis (7.2% vs 2.9%, p = 0.006) and the use of antibiotics (6.1% vs 0.7%, p = 0.000) in the cohort based on SCO. There was no delay in diagnosis. CONCLUSIONS SCO in neonates ≥35 weeks' gestation at risk for EOS, including chorioamnionitis-exposed infants, is a feasible measure that reduces laboratory evaluations and the overuse of antibiotics respecting the bonding mother-infant.
Collapse
Affiliation(s)
| | | | | | - Sonia León García
- Neonatology Department, General University Hospital, Castellon, Spain
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juan Diego Toledo
- Neonatology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| |
Collapse
|
13
|
Murphy HJ, Thomas B, Van Wyk B, Tierney SB, Selewski DT, Jetton JG. Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists. Pediatr Nephrol 2020; 35:2077-2088. [PMID: 31605211 DOI: 10.1007/s00467-019-04350-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/21/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
Abstract
Neonatal acute kidney injury (AKI) is common. Critically ill neonates are at risk for AKI for many reasons including the severity of their underlying illnesses, prematurity, and nephrotoxic medications. In this educational review, we highlight four clinical scenarios in which both the illness itself and the medications indicated for their treatment are risk factors for AKI: sepsis, perinatal asphyxia, patent ductus arteriosus, and necrotizing enterocolitis. We review the available evidence regarding medications commonly used in the neonatal period with known nephrotoxic potential, including gentamicin, acyclovir, indomethacin, vancomycin, piperacillin-tazobactam, and amphotericin. We aim to illustrate the complexity of decision-making involved for both neonatologists and pediatric nephrologists when managing infants with these conditions and advocate for ongoing multidisciplinary collaboration in the development of better AKI surveillance protocols and AKI mitigation strategies to improve care for these vulnerable patients.
Collapse
Affiliation(s)
- Heidi J Murphy
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Brady Thomas
- Stead Family Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA
| | - Brynna Van Wyk
- Stead Family Department of Pediatrics, Division of Nephrology, Dialysis, and Transplantation, University of Iowa, 200 Hawkins Drive, 2027 BT, Iowa City, IA, 52241, USA
| | - Sarah B Tierney
- Department of Pharmaceutical Care, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer G Jetton
- Stead Family Department of Pediatrics, Division of Nephrology, Dialysis, and Transplantation, University of Iowa, 200 Hawkins Drive, 2027 BT, Iowa City, IA, 52241, USA.
| |
Collapse
|
14
|
Koucky M, Kamel R, Vistejnova L, Kalis V, Ismail KM. A global perspective on management of bacterial infections in pregnancy: a systematic review of international guidelines. J Matern Fetal Neonatal Med 2020; 35:3751-3760. [PMID: 33115310 DOI: 10.1080/14767058.2020.1839879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Maternal sepsis is a leading cause of maternal and neonatal mortality. Despite the availability of management protocols, there is disparity in case fatality rates for pregnancy-related sepsis compared to other maternity-related complications. The main aim of this systematic review was to assess concordance between international evidence-based guidelines for the prevention and management of childbirth-related bacterial infections. MATERIAL AND METHODS The PRISMA statement was followed during the conduct and reporting of this review. PubMed was searched electronically from 2009 to November 2019 for clinical guidelines covering the topic of childbirth-related infections and specific searches for relevant guidelines on the websites of the top five international professional bodies most commonly identified by our searches. We did not apply any language restrictions. Guidelines were included if they provided any information about the prevention or management of childbirth-related bacterial infections irrespective of whether the guideline stated a recommendation or not. Two independent reviewers undertook study selection, decisions about inclusion of selected guidelines and data extraction. Extracted information was synthesized under the following topics: Asymptomatic bacteriuria; group B streptococcal infection (GBS); preterm premature rupture of membranes (P-PROM); intrauterine infection; procedures; maternal sepsis; miscellaneous. Concordance was defined as absence of contradictory information between the different guidelines with regards to a specific topic, subtopic or recommendation. Quality of included guidelines was assessed against the AGREE II guideline reporting domains. RESULTS A total of 43 guidelines were selected of which 11 were excluded leaving 32 guidelines that fulfilled our inclusion criteria. None of the guidelines fulfilled all the quality assessment domains and 11 (34%) of the guidelines satisfied 1-2 of domains only. Two guidelines covered the topic of asymptomatic bacteriuria, nine for GBS, five for P-PROM and three covered each of intra-amniotic infections maternal sepsis, obstetric procedures and interventions topics. The remaining guidelines covered miscellaneous topics. CONCLUSIONS There was concordance between guidelines with regards to several aspects in the prophylaxis and treatment of bacteriological infections in pregnancy. Nevertheless, there were several areas of discordance, some of which reached the extent of contradictory information as in the case of antenatal screening for GBS.
Collapse
Affiliation(s)
- Michal Koucky
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital in Prague, Prague, Czech Republic
| | - Rasha Kamel
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Lucie Vistejnova
- Biomedical center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimir Kalis
- Biomedical center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Khaled M Ismail
- Biomedical center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| |
Collapse
|
15
|
Santana FAF, de Oliveira TVL, Filho MBDS, da Silva LSC, de Brito BB, de Melo FF, Souza CL, Marques LM, Oliveira MV. Streptococcus agalactiae: Identification methods, antimicrobial susceptibility, and resistance genes in pregnant women. World J Clin Cases 2020; 8:3988-3998. [PMID: 33024755 PMCID: PMC7520794 DOI: 10.12998/wjcc.v8.i18.3988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.
AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista, in Bahia State, Brazil.
METHODS From January 2017 to February 2018, vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth. Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies. Then, disk diffusion antibiograms were performed in GBS-positive samples, and the detection of the resistance genes ermB, ermTR, mefA, and linB in the clindamycin and/or erythromycin-resistant samples was carried out.
RESULTS Thirty-two samples (17.2%) were GBS-positive. The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method (96.9%) for GBS detection. All isolates were susceptible to penicillin, ampicillin, cefotaxime, and vancomycin. Clindamycin resistance was observed in 6 samples (18.8%), while 8 samples (25%) were erythromycin-resistant. All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests. Two strains (25%) presented an M phenotype and 6 isolates (75%) presented a cMLSB phenotype. The ermB gene was identified in 4 samples (44.4%), the mefA gene was also found in 4 samples (44.4%), the ermTR gene was identified in 1 isolate (11.1%), and the linB gene was not found in any isolate.
CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods, including chromogenic media, and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.
Collapse
Affiliation(s)
| | - Tais Viana Ledo de Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lucas Miranda Marques
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
- Campus Soane Nazaré de Andrade, Universidade Estadual de Santa Cruz, Ilhéus 45662900, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| |
Collapse
|
16
|
Nadeau HCG, Edwards RK. Prophylaxis Against Early-onset Group B Streptococcus Infections in Pregnant Women Who Are Allergic to Penicillin. Clin Obstet Gynecol 2020; 62:771-780. [PMID: 30998602 DOI: 10.1097/grf.0000000000000455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Group B Streptococcus (GBS) infection remains a significant cause of neonatal morbidity and mortality. Adoption of screening for maternal genital tract colonization and intrapartum antibiotic prophylaxis has significantly reduced early-onset neonatal GBS infections. For women with an allergy to penicillin, recommended agents for prophylaxis have been well-outlined, but compliance with guideline recommendations is poor. There have been ongoing efforts in vaccine development, but no vaccination currently is available for either preconception or antenatal administration. This article will review established screening techniques, intrapartum antibiotic prophylactic regimens, and management specifically of the penicillin-allergic pregnant woman who is colonized with GBS.
Collapse
Affiliation(s)
- Hugh C G Nadeau
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | |
Collapse
|
17
|
Khalil N, Blunt HB, Li Z, Hartman T. Neonatal early onset sepsis in Middle Eastern countries: a systematic review. Arch Dis Child 2020; 105:639-647. [PMID: 31969351 DOI: 10.1136/archdischild-2019-317110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Early onset neonatal sepsis (EOS) accounts for a significant portion of neonatal mortality, which accounts for 46% of global under five child mortality. OBJECTIVE This systematic review studies the bacterial aetiology of EOS in the Middle East, susceptibility patterns to recommended empirical antibiotic therapy and whether this differs between high-income and middle-income countries in the region. METHODS Articles were collected from Medline, Web of Science, the Cochrane Library and Index Medicus for the Eastern Mediterranean Region. The articles included in our systematic review met the following criteria: published after January 2000, data relevant to the Middle East, data specific for early onset sepsis, no language restriction. Data on aetiology and susceptibility were extracted from prospective and retrospective studies. Risk of bias was assessed using the Newcastle-Ottawa Scale. This study focused on EOS but does include data regarding neonatal late-onset sepsis antibiotic susceptibility. The data regarding coagulase-negative Staphylococcus species were excluded from final analysis, as possible contaminants. The protocol for this systematic review was registered on PROSPERO: CRD42017060662. RESULTS 33 articles from 10 countries were included in the analysis. There were 2215 cases of culture-positive EOS, excluding coagulase-negative Staphylococcus. In middle-income countries, Klebsiella species (26%), Staphylococcus aureus (17%) and Escherichia coli (16%) were the most common pathogens, in contrast to group B Streptococcus (26%), E. coli (24%) and Klebsiella (9%) in high-income countries. Overall susceptibility to ampicillin/gentamicin and third-generation cephalosporin were 40% and 37%, respectively, in middle-income countries versus 93% and 91%, respectively, in high-income countries. CONCLUSIONS EOS in middle-income countries was more likely to be due to Gram-negative pathogens and less likely to be susceptible to empirical antibiotic therapy. This has important public health implications regarding neonatal mortality in the Middle East region.
Collapse
Affiliation(s)
- Nadim Khalil
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA .,Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire, USA
| | - Zhongze Li
- Biostatistics Shared Resource, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Tyler Hartman
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
18
|
Abstract
The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.
Collapse
Affiliation(s)
- Kristi Watterberg
- Department of Pediatrics, The University of New Mexico, Albuquerque, New Mexico
| | | |
Collapse
|
19
|
Alshengeti A, Alharbi A, Alraddadi S, Alawfi A, Aljohani B. Knowledge, attitude and current practices of pregnant women towards group B streptococcus screening: cross-sectional study, Al-Madinah, Saudi Arabia. BMJ Open 2020; 10:e032487. [PMID: 32054626 PMCID: PMC7045259 DOI: 10.1136/bmjopen-2019-032487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS Group B streptococcus (GBS) is one of the most frequent bacterial pathogens causing invasive infections in neonates. It can be transmitted from colonised mother to neonates around delivery. Screening strategies for GBS during pregnancy include either universal culture-based or risk-based screening. The present study aimed to assess the knowledge, attitude and current practices of pregnant women towards GBS screening in Al-Madinah City, Saudi Arabia. METHODS A hospital-based cross-sectional study was conducted at Madinah Maternity and Children Hospital, Al-Madinah, Saudi Arabia, from May to July 2018. Participants were recruited from postnatal wards. Participants were interviewed using a previously published validated survey that was divided into the following domains: demographic data, knowledge, experience and attitude towards different GBS screening strategies. RESULTS A total of 377 out of 450 women (response rate 83.7%) were enrolled. The results showed that the overall mean knowledge score of the pregnant women towards GBS screening was 59.8%. Majority of the women (66.8%) were not aware of the GBS bacterium, while 86.5% of them had never been informed of GBS risk assessment during their pregnancies. The mean knowledge score among women who were aware of GBS (62.8%) was significantly higher than that among women who were not (58.4%) (p=0.015). However, majority of the pregnant women (61.8%) showed preference for universal culture-based GBS screening strategy over risk-based strategy. CONCLUSION The study results have concluded that the level of awareness and knowledge about GBS among pregnant women were relatively poor; however, majority of the pregnant women prefer universal culture-based screening.
Collapse
Affiliation(s)
- Amer Alshengeti
- Pediatric Department, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Amjad Alharbi
- Pediatric Department, Madinah Maternity and Children Hospital, Madinah, Saudi Arabia
| | - Shahad Alraddadi
- Radiology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdulsalam Alawfi
- Pediatric Department, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Bushra Aljohani
- Obstetrics and Gynecology Department, Madinah Maternity and Children Hospital, Medinah, Saudi Arabia
| |
Collapse
|
20
|
Ahmed M, Ejaz M, Jahangeer A, Khan S, Riaz Hashmi SS, Jawaid T, Nasir S. Frequency and Associated Factors of Parental Refusal to Perform Lumbar Puncture in Children with Suspected Central Nervous System Infection: A Cross-sectional Study. Cureus 2019; 11:e5653. [PMID: 31700755 PMCID: PMC6822552 DOI: 10.7759/cureus.5653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Lumbar puncture (LP) is a useful procedure which is performed for both diagnosis and treatment of numerous conditions affecting children and adults. The purpose of this study was to determine the frequency and cause of increased parental refusal to perform LP in the pediatric population. Method A cross-sectional study was conducted from January 2018 to June 2019 at the Civil Hospital, Dow University of Health Sciences, pediatric department, Civil Hospital, Karachi. Over the 18-month time period, a total of 215 patients who had indications of LP were selected from the in-patient pediatrics department; the age range was between newborn to 12 years of age. The mode of research was a questionnaire and interview-based method that was conducted with guardians of minor patients to understand the extent of their knowledge and awareness about the LP procedure as well as its complication and the role of culture, education background, and financial status of the families which may lead to an increased likelihood of refusal. Result The frequency of LP refusal amongst the 215 families of the patients that were interviewed was found to be 32.6%. Mean age of the respondents was 30.98 years. The decision for LP was not significantly affected by the subjects’ gender (p=0.1), by the religious communities to which the families belonged (p=0.9), their ethnicities (0.52), or by the families’ financial status (p=0.4). It was observed that when indications for performing LP were appropriately explained, there was a significantly greater number of consents given as compared to when they were not made clear (p=0.009). Explaining the complications of the procedure did not considerably impact the decision for refusal of the procedure (p=0.1). The multi-variable logistic regression analysis model was applied to determine the likelihood of variables affecting refusal of LP and the logistic regression model was found to be statistically significant, χ2 (8) = 38.2 p < 0. 001. Conclusion Lack of knowledge about the LP procedure and fear of ramification plays a conspicuous role in the denial of LP procedure by the guardians of minor patients. A better, simpler approach using standardized consent forms by the doctors may lead to the removal of the information gaps and can provide a better understanding about the concerned risks, the primary indications, and the benefits of this procedure to the guardians.
Collapse
Affiliation(s)
- Mushtaq Ahmed
- Pediatrics, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Muzamil Ejaz
- Pediatrics, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Ashraf Jahangeer
- Epidemiology, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Sumaiya Khan
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | | | - Tabinda Jawaid
- Internal Medicine, Baqai Medical University, Karachi, PAK
| | - Saad Nasir
- Internal Medicine, United Medical and Dental College/Creek General Hospital, Karachi, PAK
| |
Collapse
|
21
|
Hershkovich-Shporen C, Ujirauli N, Oren S, Juster Reicher ADA, Gadassi N, Guri A, Flidel-Rimon O. Not all newborns born to mothers with clinical chorioamnionitis need to be treated. J Matern Fetal Neonatal Med 2019; 34:1949-1954. [DOI: 10.1080/14767058.2019.1651281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Neli Ujirauli
- Department of Pediatrics, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
| | - Shachar Oren
- Department of Pediatrics, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
| | - ADA Juster Reicher
- Department of Neonatology, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
| | - Noa Gadassi
- Department of Neonatology, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
| | - Alex Guri
- Department of Pediatrics, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
| | - Orna Flidel-Rimon
- Department of Neonatology, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
| |
Collapse
|
22
|
Kralik SF, Kukreja MK, Paldino MJ, Desai NK, Vallejo JG. Comparison of CSF and MRI Findings among Neonates and Infants with E coli or Group B Streptococcal Meningitis. AJNR Am J Neuroradiol 2019; 40:1413-1417. [PMID: 31320464 DOI: 10.3174/ajnr.a6134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Group B Streptococcus and Escherichia coli (E coli) are the 2 most common causes of bacterial meningitis in neonates. The purpose of this study was to determine whether CSF and/or MR imaging findings differ between infants with group B streptococcal or E coli meningitis. MATERIALS AND METHODS A retrospective review was performed among neonates (younger than 28 days) and infants (younger than 120 days) with proved group B streptococcal (n = 57) or E coli meningitis (n = 50). A CSF or blood culture positive for Streptococcus or E coli and an elevated CSF white blood cell count were used as the criterion standard. Independent, blinded review of brain MRIs obtained within 21 days of presentation were performed by 2 board-certified neuroradiologists. CSF laboratory values and MR imaging findings were compared between the groups. RESULTS There was no statistically significant difference between the mean age at presentation for patients with group B streptococcal (40 days; range, 2-111 days) versus patients with E coli meningitis (31 days; range, 12-115 days) (P = .18). There was no statistically significant difference in the CSF white blood cell count, glucose, or protein. There was a significant difference between group B streptococcal and E coli meningitis in the frequency of hydrocephalus (0% versus 22%, P = .001) and infarct (40% versus 14%; P = .038), respectively. There was no statistically significant difference in leptomeningeal enhancement, cerebritis, ventriculitis, abscess/granuloma, subdural effusion, extra-axial purulent material, intraventricular purulent material, hemorrhage, and sinus thrombosis. CONCLUSIONS Although neonates and infants with group B streptococcal or E coli meningitis had similar age and CSF laboratory values, patients with group B streptococcal meningitis more frequently demonstrated infarcts, while those with E coli meningitis more frequently had early onset of hydrocephalus.
Collapse
Affiliation(s)
- S F Kralik
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
- Indiana University Riley Children's Hospital (S.F.K.), Indianapolis, Indiana
| | - M K Kukreja
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
| | - M J Paldino
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
| | - N K Desai
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
| | - J G Vallejo
- Department of Pediatrics (J.G.V.), Baylor College of Medicine, Houston, Texas
| |
Collapse
|
23
|
Jones DM, Haikal SO, Whitham MD, Howard DL. Universal versus Risk-Based Management of Unknown Group B Streptococcus Status at Term. AJP Rep 2019; 9:e315-e322. [PMID: 31579529 PMCID: PMC6768794 DOI: 10.1055/s-0039-1695744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives This article estimates and compares public health costs of universal versus risk-based intrapartum antibiotic prophylaxis (IAP) administration for women with unknown Group B streptococcus (GBS) status at term. Study Design The annual number of women in the U.S. who are: unscreened for GBS, without risk factors, delivering vaginally, multiparous, and eligible for discharge within 24 hours was estimated. Under the risk-based strategy, women and neonates were assumed to stay another day for observation and incur the cost of an additional 24-hour stay. With universal IAP administration, women delivering without complications were assumed to be discharged within 24 hours, with an incurred cost of penicillin. Results The estimated cost for the risk-based management of unscreened women at term without rupture of membranes (ROM) > 18 hours ranged from $468,886,831 to $850,556,179. Similarly, the cost of managing unscreened women without maternal intrapartum fever (MIF) ranged from $742,024,791 to $919,269,233. Alternatively, universal IAP administration costs ranged from $470,107,674 to $568,359,086.5. Cost comparisons yielded an equivalence or up to a 33.2% reduction in cost, and 36.6 to 38.2% reduction in cost for women without ROM > 18 hours and MIF, respectively. Conclusions Universal IAP may be cost saving due to the reduction in extended hospitalizations for neonates and healthy mothers.
Collapse
Affiliation(s)
- Danielle M Jones
- School of Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada
| | - Samantha O Haikal
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada
| | - Megan D Whitham
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - David L Howard
- School of Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada.,College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada.,Las Vegas Minimally Invasive Surgery and Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada
| |
Collapse
|
24
|
Hsu JF, Chen CL, Lee CC, Lien R, Chu SM, Fu RH, Chiang MC, Yang CY, Lai MY, Wu IH, Yen YS, Chiu CH. Characterization of group B Streptococcus colonization in full-term and Late-Preterm neonates in Taiwan. Pediatr Neonatol 2019; 60:311-317. [PMID: 30145107 DOI: 10.1016/j.pedneo.2018.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Group B streptococcus (GBS) infections can be life-threatening in newborns. This study aimed to analyze GBS carriage status and genotypic diversity in healthy neonates after implementation of intrapartum antibiotic prophylaxis (IAP) in Taiwan. METHODS Newborns carrying GBS were identified from a screen of 500 newborns and followed up until their cultures turned negative. Their mothers' GBS screening data were reviewed. Molecular methods, including capsular serotyping, multilocus sequence typing and pulsed-field gel electrophoresis (PFGE), were used to analyze GBS isolates. RESULTS GBS colonization was detected at either the nose or anus in 11 of 500 healthy neonates (2.2%). In this group of 11 neonates, 4 had GBS serotypes II and III for 4-6 months, 1 had serotype V for 2 months, 6 had serotypes Ia, II, V, and VI for less than 1 month, and 1 had 2 different serotypes (serotypes V and II) at different times. The most prevalent serotype was II (33.3%), followed by Ia (25.0%), III (16.7%), V (16.7%), and VI (8.3%). The main sequence type was ST1 (50.0%), followed by ST19 (16.7%), ST23 (8.3%), ST24 (8.3%), ST103 (8.3%), and ST 231 (8.3%). All isolates were grouped into 5 PFGE clusters F, G, J, X, and Y, and all were susceptible to β-lactam antimicrobial agents. CONCLUSIONS GBS was carried in 2.2% (11/500) healthy newborns and persisted for 6 months in 3 neonates. This study makes clearer our understanding of GBS colonization, serotype distribution, and genotype distribution in healthy neonates.
Collapse
Affiliation(s)
- Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Chung Lee
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Huei Fu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chang-Yo Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Hsyuan Wu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Shan Yen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
25
|
Bouchet N, Joal A, Gayet-Ageron A, Areta ML, Martinez de Tejada B. Impact of the new guidelines on the management of premature rupture of membranes for the prevention of late preterm birth: an 11-year retrospective study. J Perinat Med 2019; 47:341-346. [PMID: 30676007 DOI: 10.1515/jpm-2018-0324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/20/2018] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate the number of late preterm (LPT) births (between 34 0/7 and 36 6/7 weeks) that could have been prevented if expectant management of preterm premature rupture of membranes (PPROM) had been applied according to new recommendations. Methods A retrospective cohort study included all births at one Swiss center between January 1, 2002 and December 31, 2012. Births were categorized using an adapted evidence-based classification. Two scenarios were considered: best scenario (maximum averted cases) and a conservative scenario (minimum averted cases). Results Among 2017 LPT births (5.0% of all deliveries; n=40,609), 1122 (60.6%) women had PPROM. Spontaneous labor occurred in 473 (42.2%) cases and 649 (57.8%) had induction of labor or an elective cesarean section. In the latter group, 44 (6.8%) had evidence-based indications for LPT delivery and 605 (83.2%) had non-evidence-based indications. Depending on the scenario, the rate of avoided LPT cases would have varied between 4.2% (95% confidence interval [CI]: 3.4-5.2) if the conservative scenario was applied, and 30% (95% CI: 28.0-32.0) for the best scenario. Conclusion Adoption of new guidelines for the management of PPROM will prevent a considerable number of LPT births and help decrease the adverse effects and potential disability associated with late preterm infants.
Collapse
Affiliation(s)
- Noémie Bouchet
- Obstetrics Service, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud Joal
- Obstetrics Service, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Clinical Research Centre and Division of Clinical Epidemiology, Department of Community Health and Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marina Lumbreras Areta
- Obstetrics Service, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Service, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
26
|
Kazmi SH, Bailey SM, Mally PV, Verma S, Borkowsky W, Howell HB. The Effect of Complete Blood Count Timing on Lumbar Puncture Rates in Asymptomatic Infants Born to Mothers with Chorioamnionitis. Cureus 2018; 10:e3737. [PMID: 30800547 PMCID: PMC6384042 DOI: 10.7759/cureus.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Maternal chorioamnionitis is a risk factor for sepsis but, often, these infants are asymptomatic at birth. Different markers for infections, such as the immature to total (I/T) white blood cell (WBC) ratio, are used to help determine which infants require lumbar punctures (LPs), in addition to blood cultures and antibiotics. The timing of when the complete blood count (CBC) is obtained may have some effect on the length of antibiotic treatment. Aims The purpose of this proof-of-concept study was to assess if obtaining a CBC at greater than four hours of life as compared to less than four hours of life has an impact on the incidence of LPs performed in asymptomatic, full-term infants undergoing evaluation for sepsis secondary to maternal chorioamnionitis. Methods We performed a retrospective study of full-term, asymptomatic infants admitted for sepsis evaluation secondary to maternal chorioamnionitis. Subjects were grouped based upon the timing of their initial CBC (early = < four hours of life or late = > four hours of life). The incidence of LPs, duration of antibiotic treatment, and length of hospitalization were compared between the groups. Results A total of 230 subjects were included in the study (early group = 124, late group = 106). Subjects in the late group underwent significantly fewer LPs than subjects in the early group, 5.7% vs. 22.6% (p<0.001). There was no difference in length of treatment or hospitalization. Conclusions Asymptomatic full-term infants undergoing evaluation for sepsis secondary to maternal chorioamnionitis are less likely to undergo an LP if their initial CBC is obtained at greater than four hours of life.
Collapse
Affiliation(s)
- Sadaf H Kazmi
- Pediatrics, New York University School of Medicine, New York, USA
| | - Sean M Bailey
- Pediatrics, New York University School of Medicine, New York, USA
| | - Pradeep V Mally
- Pediatrics, New York University School of Medicine, New York, USA
| | - Sourabh Verma
- Pediatrics, New York University School of Medicine, New York, USA
| | | | - Heather B Howell
- Pediatrics, New York University School of Medicine, New York, USA
| |
Collapse
|
27
|
Chen JC, Jenkins-Marsh S, Flenady V, Ireland S, May M, Grimwood K, Liley HG. Early-onset group B streptococcal disease in a risk factor-based prevention setting: A 15-year population-based study. Aust N Z J Obstet Gynaecol 2018; 59:422-429. [PMID: 30203834 DOI: 10.1111/ajo.12891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/29/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intrapartum chemoprophylaxis reduces early-onset group B streptococcal disease (EOGBSD) in newborns. Some guidelines advise that intrapartum antibiotics should be offered following universal antenatal screening for GBS carriage and others recommend intrapartum antibiotics based on clinical risk factors alone. Since 1999, Queensland guidelines have recommended a risk factor-based approach. We examined trends in EOGBSD rates over time in Queensland in the setting of these guidelines and whether management of cases reflected the recommendations. METHODS A state-wide retrospective search of pathology databases, allowing near-complete, population-based case identification, was conducted to detect live-born infants from January 2000 to December 2014 with GBS cultured from blood or cerebrospinal fluid within seven days of age. A nested audit of EOGBSD cases comparing two epochs, 2000-2010 and 2011-2014, was performed to determine patient characteristics and guideline adherence for each case. RESULTS Mean incidence of EOGBSD in Queensland from 2000 to 2014 was 0.33 per 1000 live births (SD± 0.08) with no changing trend over time. The case-mortality rate in the 2011-2014 epoch was 1.2% compared to 11.9% in 2000-2004 (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.002-0.67). The proportion of EOGBSD cases who were preterm infants decreased from 29.8% to 13.3% (OR 0.36, 95% CI 0.14-0.84). Of cases with risk factors in the 2011-2014 epoch, 46% received intrapartum antibiotics compared to 25% in 2000-2004 (OR 2.49, 95% CI 0.86-7.58, P = 0.09). CONCLUSIONS EOGBSD incidence rate in Queensland remained low during 2000-2014. However, both the 2011-2014 case-mortality rate and the proportion of preterm cases significantly decreased. Missed opportunities for intrapartum chemoprophylaxis remain.
Collapse
Affiliation(s)
- Julie C Chen
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Sue Jenkins-Marsh
- Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Susan Ireland
- Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Meryta May
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia.,Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Infectious Diseases, School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Helen G Liley
- Faculty of Clinical Medicine and Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age With Bacterial Meningitis in the United Kingdom and Ireland. Pediatr Infect Dis J 2018; 37:837-843. [PMID: 29384979 DOI: 10.1097/inf.0000000000001917] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To describe the clinical characteristics and risk factors associated with poor outcome in infants <90 days of age with bacterial meningitis. METHODS Prospective, enhanced, national population-based active surveillance for infants <90 days of age with bacterial meningitis in the United Kingdom and Ireland between July 2010 and July 2011. Infants were identified through the British Paediatric Surveillance Unit, laboratory surveillance and meningitis charities. RESULTS Clinical details was available for 263 of 298 (88%) infants where a bacterium was identified, 184 (70%) were born at term. Fever was reported in 143 (54%), seizures in 73 (28%), bulging fontanelle in 58 (22%), coma in 15 (6%) and neck stiffness in 7 (3%). Twenty-three (9%) died and 56/240 (23%) of the survivors had serious central nervous system complications at discharge. Temperature instability [odds ratio (OR), 2.99; 95% confidence interval (CI): 1.21-7.41], seizures (OR, 7.06; 95% CI: 2.80-17.81), cerebrospinal fluid protein greater than the median concentration (2275 mg/dL; OR, 2.62; 95% CI: 1.13-6.10) and pneumococcal meningitis (OR, 4.83; 95% CI: 1.33-17.58) were independently associated with serious central nervous system complications while prematurity (OR, 5.84; 95% CI: 2.02-16.85), low birthweight (OR, 8.48; 95% CI: 2.60-27.69), coma at presentation (OR, 31.85; 95% CI: 8.46-119.81) and pneumococcal meningitis (OR, 4.62; 95% CI: 1.19-17.91) were independently associated with death. CONCLUSIONS The classic features of meningitis were uncommon. The presentation in young infants is often nonspecific, and only half of cases presented with fever. A number of clinical and laboratory factors were associated with poor outcomes; further research is required to determine how knowledge of these risk factors might improve clinical management and outcomes.
Collapse
|
29
|
Scheel M, Perkins S. Hit or Miss? A Review of Early-Onset Sepsis in the Neonate. Crit Care Nurs Clin North Am 2018; 30:353-362. [PMID: 30098739 DOI: 10.1016/j.cnc.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
For the bedside nurse identifying at-risk neonates for development of early-onset sepsis is a challenge. The ambiguity of clinical presentation can easily be overlooked, resulting in delayed treatment of this vulnerable population. Adding to this dilemma is inconsistent implementation of screening criteria used by health providers to identify at-risk neonates, resulting in lost opportunities of early identification and treatment. This article discusses the current approach to and the nurse's role in early-onset sepsis.
Collapse
Affiliation(s)
- Monica Scheel
- Delgado Community College-Charity School of Nursing, 450 South Claiborne Avenue, New Orleans, LA 70112, USA
| | - Shannon Perkins
- Delgado Community College-Charity School of Nursing, 450 South Claiborne Avenue, New Orleans, LA 70112, USA.
| |
Collapse
|
30
|
Assefa S, Desta K, Lema T. Group B streptococci vaginal colonization and drug susceptibility pattern among pregnant women attending in selected public antenatal care centers in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2018; 18:135. [PMID: 29728084 PMCID: PMC5935928 DOI: 10.1186/s12884-018-1791-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Group B Streptococcus (GBS) is the leading cause of septicemia, meningitis, and pneumonia in neonates. Maternal colonization with GBS is the principal risk factor for early-onset disease in infants. Group B Streptococcus is now an important cause of maternal and neonatal morbidity and mortality in many parts of the world. In Ethiopia, few studies have been done on GBS colonization among pregnant women. The aim of this study was to determine the prevalence of GBS colonization, antimicrobial susceptibility patterns and assess risk factors among pregnant women. Methods A prospective cross-sectional study was conducted from May to August 2014 at selected public antenatal care (ANC) centers in Addis Ababa, Ethiopia. Clinical and socio-demographical data were collected using structured questionnaire after obtaining written informed consent. A total of 281 lower vaginal swabs were collected and inoculated into 1 ml Todd Hewitt Broth supplemented with gentamicin and nalidixic acid to prevent the growth of contaminants. After overnight incubation, all broths were subcultured on 5% sheep blood agar for isolation of GBS. Antimicrobial susceptibility testing was performed according to the criteria of the Clinical and Laboratory Standard Institute (CLSI) guidelines 2013 by disk diffusion method. Data were entered and analysed using SPSS version 20.0 software. Chi-square test and binary logistic regression analysis were used. P-value < 0.05 was considered statistically significant. Results The overall prevalence of GBS colonization among pregnant women was 14.6% (41/281). Group B Streptococcus colonization was significantly associated with health institutions (P < 0.05). All GBS isolates were susceptible to chloramphenicol. Resistance to tetracycline, cefotaxime, clindamycin, penicillin, vancomycin, ampicillin and erythromycin was 90.2%, 34.1, 26.8%, 19.5, 17%, 14.6 and 7.5% respectively. Multidrug resistance (MDR) (≥ 2 drugs) was detected in 43.9% (18/41) of the isolates. Conclusion There was a high frequency of GBS colonization (14.6%) and resistance to the commonly used antibiotics which suggests the importance of the screening of GBS colonization in pregnant women at 35–37 weeks of gestation and testing their antimicrobial susceptibilities in order to provide antibiotic prophylaxis and minimize newborn infection and co-morbidity.
Collapse
Affiliation(s)
- Solomon Assefa
- Ethiopian Public Health Institute, P.O. Box 1242, Arbegnoch Street, Addis Ababa, Ethiopia.
| | - Kassu Desta
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Tsehaynesh Lema
- Armauer Hansen Research Institute, P.O. Box 1005, Jimma Road, Addis Ababa, Ethiopia.,All Africa Leprosy, Tuberculosis, Rehabilitation and Training Center, P.O. Box 165, Jimma Road, Addis Ababa, Ethiopia
| |
Collapse
|
31
|
Escribano García C, del Mar Montejo Vicente M, Izquierdo Caballero R, Samaniego Fernández CM, Marín Urueña SI, Infante López ME, Caserío Carbonero S. Clinical observation of newborns with infection risk: A safe practice. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
32
|
Shakib JH. Newborn Early-Onset Sepsis Guidelines: The Not So Simple Truth. Hosp Pediatr 2018; 8:302-303. [PMID: 29674562 DOI: 10.1542/hpeds.2018-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Julie H Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| |
Collapse
|
33
|
Berardi A, Pietrangiolillo Z, Bacchi Reggiani ML, Bianco V, Gallesi D, Rossi K, Facchinetti F, Ferrari F. Are postnatal ampicillin levels actually related to the duration of intrapartum antibiotic prophylaxis prior to delivery? A pharmacokinetic study in 120 neonates. Arch Dis Child Fetal Neonatal Ed 2018; 103:F152-F156. [PMID: 28663282 DOI: 10.1136/archdischild-2016-312546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/12/2017] [Accepted: 05/22/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess ampicillin levels according to the duration of intrapartum antibiotic prophylaxis (IAP). DESIGN Prospective cohort single-centre study. SETTING Tertiary care centre (Modena, Italy). PATIENTS 120 neonates≥35 weeks' gestation exposed to IAP. INTERVENTIONS Neonates were divided into four groups, according to the duration of IAP prior to delivery: group 1 (n=30; <1 hour), group 2 (n=30; ≥1 and <2 hours), group 3 (n=30; ≥2 and <4 hours) and group 4 (n=30; ≥2 doses, ≥4 hours). MAIN OUTCOME MEASURES Blood samples were collected at delivery (from the umbilical cord) and at age 4 hours (from a peripheral vessel). RESULTS Median duration of IAP was 121 min (range 7-2045 min). Median ampicillin levels in umbilical cord blood were 10.4 µg/mL (IQR 6.4-14.9) and in peripheral blood were 4.7 µg/mL (IQR 2.8-6.4µg/mL). Umbilical cord blood levels reached a peak approximately 30 min after IAP and then declined significantly (p<0.001). Peripheral blood levels did not differ among study groups. Neonates exposed to a full loading dose (n=115) had peripheral blood levels 2.5-70 times higher than the minimal inhibitory concentration for group B streptococcus. There was no relationship between neonatal ampicillin concentrations and the duration of IAP prior to delivery (β=-0.0003, 95% CI -0.02 to 0.001, p=0.680). CONCLUSIONS Ampicillin levels reach a peak in the umbilical cord blood within 30 min of intrapartum administration. After a full loading dose, bactericidal levels persist for at least 4 hours after birth and seem independent of the duration of IAP prior to delivery.
Collapse
Affiliation(s)
- Alberto Berardi
- Unit Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Zaira Pietrangiolillo
- Unit Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Maria Letizia Bacchi Reggiani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Valentina Bianco
- Unit Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Daniela Gallesi
- Unità di Tossicologia e Farmacologia Clinica, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Katia Rossi
- Unit Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Fabio Facchinetti
- Unità Operativa di Ostetricia, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Fabrizio Ferrari
- Unit Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| |
Collapse
|
34
|
Stafford IA, Rodrigue E, Berra A, Adams W, Heard AJ, Hagan JL, Stafford SJ. The strong correlation between neonatal early-onset Group B Streptococcal disease and necrotizing enterocolitis. Eur J Obstet Gynecol Reprod Biol 2018; 223:93-97. [PMID: 29501938 DOI: 10.1016/j.ejogrb.2018.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a leading cause of newborn gastrointestinal emergencies, affecting 1-3 per 1000 live births. Although NEC has been linked to a microbial etiology, associations with maternal intrapartum and resultant newborn early-onset invasive Group B streptococcus (EO-GBS) have been weakly defined. OBJECTIVE The study aim was to determine the relationship between EO-GBS and NEC. STUDY DESIGN Data from 2008 to 2015 were collected from pediatric records with ICD diagnosis codes consistent with all stages of NEC, with the exception of neonatal EO-GBS data (only available 2011-2015). RESULTS For the 131 newborns meeting inclusion criteria, the mean gestational age (GA) and birthweight at delivery was 30.2 weeks and 1449 g. Maternal comorbidities were not associated with a more advanced stage of NEC, however male gender (OR 3.2, p < .001), lower mean 1 (OR = 0.89, p = .045) and 5 min Apgar scores (OR = 0.84, p = .009) were significantly associated with higher NEC stage, after controlling for GA. Infectious morbidities including chorioamnionitis (OR = 1.5, p = .553) and intrapartum antibiotic administration (OR = 1.3, p = .524) were not significantly associated with higher NEC stage. Neither neonatal sepsis workup (OR = 0.27, p = .060) nor positive blood culture (OR = 0.97, p = .942) prior to NEC diagnosis were statistically significant. Type of feed prior to diagnosis (p = .530) was not significantly associated with NEC stage, however, expressed breast milk tended to be protective against higher stage of NEC (OR = 0.49, p = .055). Type of feed included total parenteral nutrition, mother's or donor expressed breast milk, trophic, full and high calorie feeds. Of the 579 newborns admitted from 2011 to 2015, 13 (2%) were diagnosed with EO-GBS and 64 met diagnostic criteria for NEC. GBS positive newborns had significantly higher odds of NEC (OR = 5.37, p = .009). NEC stage was not significantly different for patients with GBS positive vs. GBS negative mothers (p = .732), nor was there a significant difference in GA (p = .161). CONCLUSION Our study is the first to describe a strong correlation between neonatal EO- GBS disease and NEC, with more than a five-fold increase in the odds of developing NEC in newborns of GBS positive mothers. PURPOSE To investigate a possible relationship between EO-GBS disease and the neonatal diagnosis of NEC. Secondary analysis will determine if maternal antepartum and intrapartum factors along with neonatal variables contribute to a more advanced stage of NEC by retrospective chart review of patient data collected at Children's Hospital: New Orleans.
Collapse
Affiliation(s)
- Irene A Stafford
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States.
| | - Eliza Rodrigue
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Alexandra Berra
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Wesley Adams
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Asha J Heard
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Joseph L Hagan
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Shawn J Stafford
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| |
Collapse
|
35
|
Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study. Am J Infect Control 2018; 46:20-25. [PMID: 28967511 DOI: 10.1016/j.ajic.2017.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. METHODS The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. RESULTS SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. CONCLUSIONS Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control.
Collapse
|
36
|
Strategies for preventing group B streptococcal infections in newborns: a nation-wide survey of Italian policies. Ital J Pediatr 2017; 43:98. [PMID: 29096709 PMCID: PMC5667472 DOI: 10.1186/s13052-017-0409-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 09/24/2017] [Indexed: 11/16/2022] Open
Abstract
Background There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. Methods Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility. Results All respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines. Conclusions The screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations. Electronic supplementary material The online version of this article (10.1186/s13052-017-0409-1) contains supplementary material, which is available to authorized users.
Collapse
|
37
|
Beaulieu E, Massé E, Dallaire F. Cord blood neutropenia is an independent predictor of early sepsis. J Perinatol 2017; 37:1204-1209. [PMID: 28837136 DOI: 10.1038/jp.2017.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/17/2017] [Accepted: 06/16/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The significance of cord blood neutropenia as a screening tool for early-onset sepsis (EOS) is unclear. The objectives were to define reference values for cord blood neutrophil count and to determine the sensitivity and positive likelihood ratio of cord neutropenia for the detection of EOS. STUDY DESIGN This retrospective observational cohort study included all mother-infant pairs with deliveries between 2009 and 2014 for whom cord neutrophil counts were routinely done. EOS cases were identified by interrogation of electronic charts. Maternal and perinatal factors were assessed to determine reference values of cord neutrophil. The diagnostic value of neutropenia for detecting EOS was assessed. A nested case-control design was used to measure the value of neutropenia in the detection of EOS in comparison with other risk factors. RESULTS A total of 8,590 mother-infant pairs were included. We identified 84 sepsis cases. The neutrophil count was strongly associated with gestational age. Neutropenia adjusted for gestational age was strongly associated with EOS and had good specificity but poor sensitivity. The addition of neutropenia to other EOS risk factors increased sensitivity without decreasing specificity. CONCLUSION Cord blood neutropenia was significantly associated with EOS and the addition of cord neutropenia to current EOS risk factors increased the detection rate of EOS.
Collapse
Affiliation(s)
- E Beaulieu
- Faculty of Medicine and Health Sciences, Department of Pediatrics, Centre de recherche du Centre hospitalier universitaire de Sherbrooke and University of Sherbrooke, Sherbrooke, QC, Canada
| | - E Massé
- Faculty of Medicine and Health Sciences, Department of Pediatrics, Centre de recherche du Centre hospitalier universitaire de Sherbrooke and University of Sherbrooke, Sherbrooke, QC, Canada
| | - F Dallaire
- Faculty of Medicine and Health Sciences, Department of Pediatrics, Centre de recherche du Centre hospitalier universitaire de Sherbrooke and University of Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|
38
|
Hershkovich-Shporen C, Bardenstein R, Blickstein I, Shinwell ES, Flidel-Rimon O. Maternal intrapartum antibiotic treatment continues to exert a bactericidal effect on the umbilical cord and peripheral venous blood of newborn infants. Acta Paediatr 2017; 106:1767-1771. [PMID: 28695642 DOI: 10.1111/apa.13982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 07/05/2017] [Indexed: 11/28/2022]
Abstract
AIM It is unclear whether maternal intrapartum antibiotic treatment (IAT) continues to exert a bactericidal effect on common pathogens in neonates. We studied the in vitro bactericidal effect of IAT on the cord and peripheral venous blood of newborn infants. METHODS Umbilical cord and peripheral venous blood from newborn infants born at Kaplan Medical Center, Israel, from April to October 2014 were studied for serum bactericidal titres against Group B Streptococcus (GBS) and Escherichia coli (E. coli) strains. We studied 60 samples of umbilical cord blood and 18 samples of peripheral venous blood from 60 newborn infants whose mothers received IAT. The controls were 10 samples of cord blood from mothers without IAT. RESULTS Cord blood exerted a bactericidal effect against 98% of GBS isolates but only 8% of E.coli isolates. Peripheral blood exerted a bactericidal effect against GBS in 94% of cases, but not against E. coli. No bactericidal effect was seen in the blood from the controls. CONCLUSION We found a continued bactericidal effect of umbilical cord blood and neonatal peripheral blood from newborn infants of IAT-treated mothers, mainly against GBS, but rarely against E. Coli. These findings may assist clinicians treating at-risk infants exposed to IAT.
Collapse
Affiliation(s)
- C Hershkovich-Shporen
- Department of Neonatology; Kaplan Medical Center, Rehovot; Hebrew University; Jerusalem Israel
| | - R Bardenstein
- Department of Microbiology; Kaplan Medical Center, Rehovot; Hebrew University; Jerusalem Israel
| | - I Blickstein
- Department of Obstetrics and Gynecology; Kaplan Medical Center, Rehovot; Hebrew University; Jerusalem Israel
| | - E S Shinwell
- Department of Neonatology; Ziv Medical Center, Tsfat; Faculty of Medicine in the Galil; Bar-Ilan University; Ramat Gan Israel
| | - O Flidel-Rimon
- Department of Neonatology; Kaplan Medical Center, Rehovot; Hebrew University; Jerusalem Israel
| |
Collapse
|
39
|
Walker S, Datta A, Massoumi RL, Gross ER, Uhing M, Arca MJ. Antibiotic stewardship in the newborn surgical patient: A quality improvement project in the neonatal intensive care unit. Surgery 2017; 162:1295-1303. [PMID: 29050887 DOI: 10.1016/j.surg.2017.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/29/2017] [Accepted: 07/29/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is significant diversity in the utilization of antibiotics for neonates undergoing surgical procedures. Our institution standardized antibiotic administration for surgical neonates, in which no empiric antibiotics were given to infants with surgical conditions postnatally, and antibiotics are given no more than 72 hours perioperatively. METHODS We compared the time periods before and after implementation of antibiotic protocol in an institution review board-approved, retrospective review of neonates with congenital surgical conditions who underwent surgical correction within 30 days after birth. Surgical site infection at 30 days was the primary outcome, and development of hospital-acquired infections or multidrug-resistant organism were secondary outcomes. RESULTS One hundred forty-eight infants underwent surgical procedures pre-protocol, and 127 underwent procedures post-protocol implementation. Surgical site infection rates were similar pre- and post-protocol, 14% and 9% respectively, (P = .21.) The incidence of hospital-acquired infections (13.7% vs 8.7%, P = .205) and multidrug-resistant organism (4.7% vs 1.6%, P = .143) was similar between the 2 periods. CONCLUSION Elimination of empiric postnatal antibiotics did not statistically change rates of surgical site infection, hospital-acquired infections, or multidrug-resistant organisms. Limiting the duration of perioperative antibiotic prophylaxis to no more than 72 hours after surgery did not increase the rate of surgical site infection, hospital-acquired infections, or multidrug-resistant organism. Median antibiotic days were decreased with antibiotic standardization for surgical neonates.
Collapse
Affiliation(s)
- Sarah Walker
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Ankur Datta
- Division of Neonatology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Roxanne L Massoumi
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Erica R Gross
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado, Stony Brook, NY
| | - Michael Uhing
- Division of Neonatology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Marjorie J Arca
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
40
|
Genotype Characterization of Group B Streptococcus Isolated From Infants With Invasive Diseases in South Korea. Pediatr Infect Dis J 2017; 36:e242-e247. [PMID: 28060047 DOI: 10.1097/inf.0000000000001531] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group B streptococcus (GBS) is one of the leading causes of invasive infections in infants. This study aimed to investigate the genotypic diversity of GBS causing invasive infections in infants and to observe the prevalence of the highly virulent clone in South Korea. METHODS Invasive strains of GBS were collected prospectively from infants admitted at 4 hospitals during 1995-2015. Serotype and multilocus sequence typing were determined. All isolates underwent polymerase chain reaction amplification to detect the presence of the hypervirulent GBS adhesin (hvgA) gene. Antibiotic susceptibility testing was done by E-test, and erythromycin resistance genes were detected using polymerase chain reaction amplification. RESULTS Among 98 GBS isolates collected, 14 sequence types (STs) were found; ST1 (20.4%), ST17 (19.4%) and ST19 (18.4%) were the most prevalent. The dominant serotype capsule expressed by ST1 was serotype V, ST17 and ST19 were all serotype III and ST23 was serotype Ia. hvgA gene was detected in 19.4% (n = 19) of the isolates; all were ST17, serotype III. A significant temporal trend of serotype III isolates was observed; as ST17 increased (P = 0.001) in proportion, ST19 decreased (P = 0.009). Erythromycin resistance was found in 42.9% (42/98); dominant strains were ermB-positive ST1 serotype V (n = 18/20, 90%), ermB-positive ST17 serotype III (n = 10/19, 52.6%) and ermA-positive ST335 serotype III (n = 7/7, 100%). CONCLUSIONS The predominant STs causing invasive infections in South Korea were ST1, ST19 and ST17. Among serotype III isolates, an increase in proportion of the hypervirulent ST17 strains was observed. Erythromycin resistance was significantly associated with ST1.
Collapse
|
41
|
Cost-effectiveness of a potential group B streptococcal vaccine for pregnant women in the United States. Vaccine 2017; 35:6238-6247. [PMID: 28951085 DOI: 10.1016/j.vaccine.2017.08.085] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/07/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the U.S., intrapartum antibiotic prophylaxis (IAP) for pregnant women colonized with group B streptococcus (GBS) has reduced GBS disease in the first week of life (early-onset/EOGBS). Nonetheless, GBS remains a leading cause of neonatal sepsis, including 1000 late-onset (LOGBS) cases annually. A maternal vaccine under development could prevent EOGBS and LOGBS. METHODS Using a decision-analytic model, we compared the public health impact, costs, and cost-effectiveness of five strategies to prevent GBS disease in infants: (1) no prevention; (2) currently recommended screening/IAP; (3) maternal GBS immunization; (4) maternal immunization with IAP when indicated for unimmunized women; (5) maternal immunization plus screening/IAP for all women. We modeled a pentavalent vaccine covering serotypes 1a, 1b, II, III, and V, which cause almost all GBS disease. RESULTS In the base case, screening/IAP alone prevents 46% of EOGBS compared to no prevention, at a cost of $70,275 per quality-adjusted life-year (QALY) from a healthcare and $51,249/QALY from a societal perspective (2013 US$). At coverage rates typical of maternal vaccines in the U.S., a pentavalent vaccine alone would not prevent as much disease as screening/IAP until its efficacy approached 90%, but would cost less per QALY. At vaccine efficacy of ≥70%, maternal immunization together with IAP for unimmunized women would prevent more disease than screening/IAP, at a similar cost/QALY. CONCLUSIONS GBS maternal immunization, with IAP as indicated for unvaccinated women, could be an attractive alternative to screening/IAP if a pentavalent vaccine is sufficiently effective. Coverage, typically low for maternal vaccines, is key to the vaccine's public health impact.
Collapse
|
42
|
La prise en charge des nouveau-nés à terme à risque de sepsis bactérien d’apparition précoce. Paediatr Child Health 2017; 22:229-235. [PMCID: PMC5804802 DOI: 10.1093/pch/pxx024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Le sepsis bactérien néonatal d’apparition précoce (SAP) se manifeste avant l’âge de sept jours. Le présent document de principes contient des recommandations à jour sur les soins aux nouveau-nés à terme (d’au moins 37 semaines d’âge gestationnel) à risque de SAP, dans les 24 heures suivant la naissance. La colonisation de la mère par le streptocoque du groupe B (SGB) pendant la grossesse en cours, la bactériurie à SGB, une maladie à SGB invasive chez un nourrisson précédent, une rupture prolongée des membranes (d’au moins 18 heures) et la fièvre de la mère (température d’au moins 38 °C) sont les facteurs de risque les plus associés au SAP. Puisque ces facteurs s’accumulent, la probabilité de SAP augmente en fonction de leur nombre. Il n’existe actuellement aucun test de laboratoire assez sensible, y compris les indices leucocytaires, pour permettre aux cliniciens d’écarter le SAP en toute sécurité. Tous les nouveau-nés malades dont les signes cliniques laissent supposer un sepsis doivent recevoir une antibiothérapie empirique après le prélèvement de cultures. La prise en charge des nouveau-nés à terme qui semblent en bonne santé, mais qui sont à risque, dépend du nombre de facteurs de risque (y compris la colonisation de la mère par le SGB) et de l’utilisation d’une antibioprophylaxie contre le SGB par la mère pendant la période intrapartum. Dans certains cas, il faut personnaliser la prise en charge. Il est essentiel d’évaluer et d’observer attentivement ces nouveau-nés à risque pour prodiguer des soins appropriés.
Collapse
|
43
|
Escribano García C, Montejo Vicente MDM, Izquierdo Caballero R, Samaniego Fernández CM, Marín Urueña SI, Infante López ME, Caserío Carbonero S. [Clinical observation of newborns with infection risk: A safe practice]. An Pediatr (Barc) 2017. [PMID: 28629714 DOI: 10.1016/j.anpedi.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Early-onset neonatal sepsis refers to an infection which starts during the first 72hours of birth, and can lead to significant morbidity and mortality. Scientific evidence shows that infected infants present with symptoms during the first hours after delivery. There has been a significant decrease in this condition with the implementation of guidelines for its prevention. However, International guidelines still recommend the evaluation of these infants using painful tests. MATERIAL AND METHODS A prospective cohort study was conducted on all asymptomatic infants born at>35 weeks gestation with one or more risk factors in a single tertiary care centre from 2011 to 2015. They were periodically observed in newborn nursery from admission until discharge looking for signs of infection. RESULTS Out of the 9,424 babies born during this period, 1425 were included in the study. A total of 53 infants were admitted to the neonatal unit, half of them because of sepsis suspicion. Finally, just 7 were discharged with the diagnosis of sepsis. All these 7 presented with symptoms during their first 72hours of life. No sepsis was reported in asymptomatic infants. CONCLUSIONS Truly infected infants present with symptoms during their first hours of life. This study supports the observation of infants at risk as a safe practice to detect early-onset sepsis.
Collapse
Affiliation(s)
- Carla Escribano García
- Servicio de Pediatría, Unidad Neonatología, Hospital Universitario Río Hortega, Valladolid, España.
| | | | | | | | - Sara Isabel Marín Urueña
- Servicio de Pediatría, Unidad Neonatología, Hospital Universitario Río Hortega, Valladolid, España
| | | | - Sonia Caserío Carbonero
- Servicio de Pediatría, Unidad Neonatología, Hospital Universitario Río Hortega, Valladolid, España
| |
Collapse
|
44
|
Jefferies AL. Management of term infants at increased risk for early-onset bacterial sepsis. Paediatr Child Health 2017; 22:223-228. [PMID: 29480905 DOI: 10.1093/pch/pxx023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Early-onset neonatal bacterial sepsis (EOS) is sepsis occurring within the first 7 days of life. This statement provides updated recommendations for the care of term (≥37 weeks' gestational age) newborns at risk of EOS, during the first 24 hours of life. Maternal Group B streptococcus (GBS) colonization in the current pregnancy, GBS bacteriuria, a previous infant with invasive GBS disease, prolonged rupture of membranes (≥18 hours) and maternal fever (temperature ≥38°C) are the factors most commonly associated with EOS. These risk factors are additive; the presence of more than one factor increases the likelihood of EOS. At present, there is no laboratory test, including white blood cell indices, that has sufficient sensitivity to allow clinicians to safely rule out EOS. All unwell infants with clinical signs suggesting sepsis must be treated empirically with antibiotics, once cultures have been taken. The management of well-appearing, at-risk term infants depends on the number of risk factors (including maternal GBS colonization) and whether maternal intrapartum antibiotic prophylaxis for GBS was used. In some cases, management should be individualized. Careful assessment and observation of these at-risk infants are a fundamental component of appropriate care.
Collapse
Affiliation(s)
- Ann L Jefferies
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| |
Collapse
|
45
|
Incidence of fever in labor and risk of neonatal sepsis. Am J Obstet Gynecol 2017; 216:596.e1-596.e5. [PMID: 28216060 DOI: 10.1016/j.ajog.2017.02.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current recommendation regarding the management of a term newborn delivered of a mother with an intrapartum fever or a diagnosis of clinical chorioamnionitis is that the neonate should have baseline laboratory work drawn along with blood cultures and be universally treated with antibiotics until culture results return. These guidelines report that the rate of intrapartum fever is about 3%; however, a few large studies suggest that the rate is higher at about 7%. OBJECTIVE We sought to prospectively evaluate the rate of fever during labor in a large number of deliveries and determine the rate of early-onset neonatal sepsis in newborns delivered from mothers with an intrapartum fever compared with newborns delivered from mothers without intrapartum fever. STUDY DESIGN This was a prospective cohort study of all temperatures obtained in women in labor from Jan. 1, 2011, through June 30, 2014. Every patient with a fever of ≥38°C at ≥36 weeks' gestation was evaluated for gestational age, parity, spontaneous or induced labor, group B streptococcus status, regional anesthesia, mode of delivery, treatment with intrapartum antibiotics, and whether a clinical diagnosis of chorioamnionitis was made by the managing physician. Neonates were assessed for blood culture results, neonatal intensive care unit admission, length of stay, and any major newborn complications. Statistical analysis involved χ2, Fisher exact, and Student t test. RESULTS A total of 412 patients (6.8%; 95% confidence interval, 6.2-7.5%) developed a fever in 6057 deliveries at ≥36 weeks' gestation. No cases of maternal sepsis occurred. Of the 417 newborns (5 sets of twins), only 1 (0.24%; 95% confidence interval, 0.01-1.3%) developed early-onset neonatal sepsis with a positive blood culture for Escherichia coli. There were 4 cases (0.07%; 95% confidence interval, 0.02-0.18%) of early-onset neonatal sepsis in the 5697 newborns (52 sets of twins) delivered from mothers who were not febrile and this difference was not significant (P = .3). The positive blood cultures in these 4 neonates were 3 group B streptococcus and 1 Enterococcus. The overall rate of early-onset neonatal sepsis in this population of newborns delivered at ≥36 weeks' gestation was 0.82/1000 deliveries. CONCLUSION The incidence of an intrapartum fever of ≥38°C in pregnancies at ≥36 weeks' gestation is common at 6.8% and this is consistent with the findings of a few other large retrospective studies. The rate of an intrapartum fever occurs in approximately 1 in 15 women in labor. The risk of neonatal sepsis in newborns delivered of mothers with intrapartum fever or a diagnosis of clinical chorioamnionitis is low at 0.24%, a rate that is <1 in 400. The recommendation for universal laboratory work, cultures, and antibiotic treatment pending culture results for this newborn population needs further examination.
Collapse
|
46
|
Hancock BM, Doran KS. Importance of strain lineages for Group B streptococcal survival. Virulence 2016; 8:646-648. [PMID: 28033037 DOI: 10.1080/21505594.2016.1271860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Bryan M Hancock
- a Department of Biology and Center for Microbial Sciences , San Diego State University , San Diego , CA , USA
| | - Kelly S Doran
- a Department of Biology and Center for Microbial Sciences , San Diego State University , San Diego , CA , USA
| |
Collapse
|
47
|
Abstract
Despite advances in intrapartum antibiotic prophylaxis (IAP), group B streptococcal infection continues to be a predominant cause of early-onset disease in neonates. About 2% of neonates exposed to group B Streptococcus develop clinical manifestations including sepsis, pneumonia, and meningitis. Screening in late pregnancy reduces the incidence of early-onset sepsis by more than 80%. Clinicians must be able to identify the risk factors and clinical manifestations of group B streptococcal infection and to understand management and prevention guidelines.
Collapse
|
48
|
Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F, Laforgia N, Ciccone MM. Early and Late Infections in Newborns: Where Do We Stand? A Review. Pediatr Neonatol 2016; 57:265-73. [PMID: 26750406 DOI: 10.1016/j.pedneo.2015.09.007] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/24/2015] [Accepted: 09/18/2015] [Indexed: 01/02/2023] Open
Abstract
Neonatal sepsis still represents an important cause of mortality and morbidity among infants. According to the onset, we can distinguish "early onset sepsis" when microbiological cultures positive for external pathogens come from newborns during the first 7 days of life (maternal intrapartum transmission); "late onset sepsis" when microbiological cultures positive for external pathogens come from newborns after the first 7 days from delivery (postnatal acquisition). In this review we synthesize the incidence, risk factors, clinical manifestations, and methods of diagnosis and treatment of each type of neonatal infection, in order to better define such a pathological condition which is of great importance in common clinical practice.
Collapse
Affiliation(s)
- Francesca Cortese
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy.
| | - Pietro Scicchitano
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy
| | - Michele Gesualdo
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy
| | - Antonella Filaninno
- Neonatology and NICU Section, Department of Biomedical Sciences and Human Oncology (DIMO) University of Bari, Bari, Italy
| | - Elsa De Giorgi
- Neonatology and NICU Section, Department of Biomedical Sciences and Human Oncology (DIMO) University of Bari, Bari, Italy
| | - Federico Schettini
- Neonatology and NICU Section, Department of Biomedical Sciences and Human Oncology (DIMO) University of Bari, Bari, Italy
| | - Nicola Laforgia
- Neonatology and NICU Section, Department of Biomedical Sciences and Human Oncology (DIMO) University of Bari, Bari, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy
| |
Collapse
|
49
|
Hooven TA, Catomeris AJ, Akabas LH, Randis TM, Maskell DJ, Peters SE, Ott S, Santana-Cruz I, Tallon LJ, Tettelin H, Ratner AJ. The essential genome of Streptococcus agalactiae. BMC Genomics 2016; 17:406. [PMID: 27229469 PMCID: PMC4881062 DOI: 10.1186/s12864-016-2741-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/14/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Next-generation sequencing of transposon-genome junctions from a saturated bacterial mutant library (Tn-seq) is a powerful tool that permits genome-wide determination of the contribution of genes to fitness of the organism under a wide range of experimental conditions. We report development, testing, and results from a Tn-seq system for use in Streptococcus agalactiae (group B Streptococcus; GBS), an important cause of neonatal sepsis. METHODS Our method uses a Himar1 mini-transposon that inserts at genomic TA dinucleotide sites, delivered to GBS on a temperature-sensitive plasmid that is subsequently cured from the bacterial population. In order to establish the GBS essential genome, we performed Tn-seq on DNA collected from three independent mutant libraries-with at least 135,000 mutants per library-at serial 24 h time points after outgrowth in rich media. RESULTS After statistical analysis of transposon insertion density and distribution, we identified 13.5 % of genes as essential and 1.2 % as critical, with high levels of reproducibility. Essential and critical genes are enriched for fundamental cellular housekeeping functions, such as acyl-tRNA biosynthesis, nucleotide metabolism, and glycolysis. We further validated our system by comparing fitness assignments of homologous genes in GBS and a close bacterial relative, Streptococcus pyogenes, which demonstrated 93 % concordance. Finally, we used our fitness assignments to identify signal transduction pathway components predicted to be essential or critical in GBS. CONCLUSIONS We believe that our baseline fitness assignments will be a valuable tool for GBS researchers and that our system has the potential to reveal key pathogenesis gene networks and potential therapeutic/preventative targets.
Collapse
Affiliation(s)
- Thomas A Hooven
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Andrew J Catomeris
- Department of Pediatrics, Division of Pediatric Infectious Diseases, New York University School of Medicine, 550 First Avenue (MSB 223), New York, NY, 10016, USA
| | - Leor H Akabas
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Tara M Randis
- Department of Pediatrics, Division of Pediatric Infectious Diseases, New York University School of Medicine, 550 First Avenue (MSB 223), New York, NY, 10016, USA
| | - Duncan J Maskell
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Sarah E Peters
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Sandra Ott
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ivette Santana-Cruz
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Luke J Tallon
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hervé Tettelin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adam J Ratner
- Department of Pediatrics, Division of Pediatric Infectious Diseases, New York University School of Medicine, 550 First Avenue (MSB 223), New York, NY, 10016, USA. .,Department of Microbiology, New York University School of Medicine, New York, NY, USA.
| |
Collapse
|
50
|
Abstract
Chorioamnionitis is a serious complication during labor at term and is associated with adverse neonatal outcome affecting approximately 10% of pregnancies. It is diagnosed clinically or microbiologically or by histopathologic examination of the placenta and umbilical cord. The clinical criteria for chorioamnionitis found in preterm or term women include maternal fever combined with 2 or more findings of maternal tachycardia, fetal tachycardia, leukocytosis, uterine tenderness, and/or malodorous amniotic fluid. These subjective findings are neither sensitive nor specific. However, clinical chorioamnionitis requires a high index of suspicion, timely diagnosis, prompt antibiotic treatment, and delivery, which may help reduce the potentially devastating outcome of maternal and neonatal infections. This article focuses on clinical chorioamnionitis and presents the physiologic immune response during pregnancy, the definition of chorioamnionitis, clinical diagnostic criteria, and implications for practice.
Collapse
|