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Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden
BACKGROUND: The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975. METHODS: Observational e...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907277/ https://www.ncbi.nlm.nih.gov/pubmed/31830941 http://dx.doi.org/10.1186/s12887-019-1866-z |
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author | Johansson Gudjónsdóttir, Margrét Elfvin, Anders Hentz, Elisabet Adlerberth, Ingegerd Tessin, Ingemar Trollfors, Birger |
author_facet | Johansson Gudjónsdóttir, Margrét Elfvin, Anders Hentz, Elisabet Adlerberth, Ingegerd Tessin, Ingemar Trollfors, Birger |
author_sort | Johansson Gudjónsdóttir, Margrét |
collection | PubMed |
description | BACKGROUND: The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975. METHODS: Observational epidemiological, retrospective study on infants 0–6 days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997–2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975. RESULTS: The total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997–2007 to 0.9/1000 LB in 2008–2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997–2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987–1996 to 0.45/1000 live births 1997–2017 and all cases were within 72 h. The proportion of extremely preterm infants (< 28 weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72 h as commensal organisms started to emerge. CONCLUSION: There has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area. KEY NOTES: This study is one of the longest running follow-ups in the world, a follow-up of 43 years of early-onset neonatal infections. The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports. No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72 h or 7 days of life. |
format | Online Article Text |
id | pubmed-6907277 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-69072772019-12-19 Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden Johansson Gudjónsdóttir, Margrét Elfvin, Anders Hentz, Elisabet Adlerberth, Ingegerd Tessin, Ingemar Trollfors, Birger BMC Pediatr Research Article BACKGROUND: The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975. METHODS: Observational epidemiological, retrospective study on infants 0–6 days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997–2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975. RESULTS: The total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997–2007 to 0.9/1000 LB in 2008–2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997–2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987–1996 to 0.45/1000 live births 1997–2017 and all cases were within 72 h. The proportion of extremely preterm infants (< 28 weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72 h as commensal organisms started to emerge. CONCLUSION: There has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area. KEY NOTES: This study is one of the longest running follow-ups in the world, a follow-up of 43 years of early-onset neonatal infections. The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports. No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72 h or 7 days of life. BioMed Central 2019-12-12 /pmc/articles/PMC6907277/ /pubmed/31830941 http://dx.doi.org/10.1186/s12887-019-1866-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Johansson Gudjónsdóttir, Margrét Elfvin, Anders Hentz, Elisabet Adlerberth, Ingegerd Tessin, Ingemar Trollfors, Birger Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden |
title | Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden |
title_full | Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden |
title_fullStr | Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden |
title_full_unstemmed | Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden |
title_short | Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden |
title_sort | changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western sweden |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907277/ https://www.ncbi.nlm.nih.gov/pubmed/31830941 http://dx.doi.org/10.1186/s12887-019-1866-z |
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