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Increased incidence of Escherichia coli sepsis in low birth weight infants

The prophylactic use of antibiotics during childbirth has significantly reduced the frequency of infections in newborns caused by group B streptococcus.

At the same time, employees of the Department of Pediatrics at the Faculty of Medicine at Emory University (Atlanta, USA) have revealed a very alarming trend to increase the frequency of sepsis caused by E.coli (including strains resistant to ampicillin) in newborns with very low body weight at birth (less than 1500 g), which researchers associate with antibiotic prophylaxis during childbirth.

The frequency of early neonatal sepsis in very low bodyweight newborns (VLBW) was analyzed before the introduction of antibiotic prophylaxis for newborn infections caused by group B streptococcus in women at risk ( 7606 childbirth cases for the period 1991-1993) and after the introduction of this method in working practice (5447 cases in 1998-2000) in 15 American neonatology clinics. It was found that the frequency of early neonatal sepsis caused by E. coli in 1991-1993. stood at 3.2 and in 1998-2000. - 6.8 per 1000 newborns with ONMT. Of the Escherichia coli strains isolated in 1998-2000, 85% were resistant to ampicillin. In addition, mothers of newborns with septicemia due to ampicillin-resistant E. coli strains were significantly more likely to receive ampicillin during pregnancy and childbirth, compared to women whose children were infected with ampicillin-sensitive strains of Escherichia coli (26/28 - 93% vs 1/5 - 20%, p = 0.01). No data on the sensitivity to antibiotics of the strains isolated in 1991-1993 could be found.

Ampicillin in combination with gentamicin is most often used as a starting therapy in newborns with suspected early neonatal sepsis. Given the results of the study, indicating a high frequency of resistance to ampicillin in pathogens of early neonatal sepsis, it is likely that consideration should be given to modifying the starting regimen of empirical antibacterial therapy, at least in the treatment of premature babies with ONMT.

Study leader Dr. Barbara J. Stoll notes that the results "are of particular concern regarding the high mortality due to sepsis caused by Escherichia coli and other Gram negative bacteria in newborns with 'ONMT, despite antibiotic therapy' It is necessary to continue epidemiological studies in a large population of newborns to assess the risk factors for the development of early neonatal sepsis, the resistance of its pathogens and the effectiveness of measures prevention in working women.