Intrapartum Antibiotic Prophylaxis and Early-Onset NeonatalSepsis Patterns

[摘要] Objective:To compare the relative effects of intrapartum antibiotic prophylaxis regimens on patterns ofearly-onset neonatal sepsis.Methods:We performed an historical cohort study of 17 187 infants born at our center from September 1993to February 2000. A risk-based strategy was employed prior to July 1996 and a screening-based strategy wasutilized thereafter. Ampicillin was utilized prior to March 1995 and penicillin was used thereafter.Results:There were 75 cases of neonatal sepsis, 34 (4.10/1000) in the risk-based era and 41 (4.63/1000) in thescreening-based era (p= 0.62). There were fewer ampicillin-resistant isolates during the risk-based thanthe screening-based era (32 versus 61%;p= 0.014). The only significant change in organism-specific sepsisrates was an increase in the rate of infection caused by coagulase-negative staphylococci in the screening-basedera (0.36 versus 1.46/1000;p= 0.018), but 75% of infants infected with these organisms were not exposed toß-lactam antibiotics within 72 h prior to delivery. For the risk- and screening-based eras, respectively, the ratesof Gram-negative sepsis (1.21 versus 1.46/1000;p= 0.65) and the proportions of Gram-negative pathogensthat were ampicillin-resistant (70 versus 77%;p= 1.0) were similar. The drug employed for prophylaxis didnot appear to affect the pattern of sepsis cases.Conclusion:In our patient population, coagulase-negative staphylococci have become the most common causeof early-onset neonatal sepsis. The cause of this shift in pathogen prevalence is uncertain and seemingly unrelatedto intrapartum antibiotic exposure.

[学科分类] 妇产科学