Researchers at Children’s Hospital of Philadelphia (CHOP) recently reviewed best practices, guidelines, and care path objectives for early-onset sepsis (EOS), an invasive bacterial or fungal infection that occurs in infants within the first week of life and can be fatal. Their recommendations were recently published in Clinics in Perinatology.
Early-onset sepsis is extremely dangerous and potentially deadly to newborns. While prescribing antibiotics during labor to prevent infections in newborns has successfully reduced cases of group B streptococcus (GBS) EOS, infection rates have plateaued. At the same time, Escherichia coli EOS rates are increasing with concerning antibiotic resistance patterns. Disparities in EOS are understudied, prompting researchers to seek a better understanding of the main issues to help promote equitable care.
“Addressing gaps in the prevention and treatment of EOS is critically important to improve outcomes,” said Dustin D. Flannery, DO, MSCE, an attending physician at CHOP, and CHOP Newborn Care at Pennsylvania Hospital, and a core faculty member in Clinical Futures, a CHOP Research Institute Center of Emphasis. “Every newborn deserves an equal chance at a healthy start.”
In the paper, the authors reviewed four current controversies in neonatal EOS: the pros and cons of administering intrapartum antibiotic prophylaxis (IAP) or the practice of giving antibiotics to pregnant women before labor to prevent infection, insight into the current plateau in EOS prevention, optimal initial antimicrobial therapy and ongoing disparities in EOS.
Researchers reported that evidence-based risk assessment can aid in the identification of both term and preterm infants at higher or lower risk of EOS. They determined that ampicillin and gentamicin are the recommended routine antibiotic regimens for suspected EOS, noting that broader coverage with additional or different antibiotics may be appropriate in specific situations. The authors also stated that novel EOS prevention strategies, such as maternal vaccination, should be prioritized to prevent infections and decrease maternal and neonatal antibiotic exposures, given the associated risks of early antibiotic exposure among uninfected newborns.
Researchers underscored that providers must be aware of disparities in the prevention, screening, and treatment of neonatal EOS. They determined that further research examining racial and ethnic disparities in EOS must focus on determining the root causes for these differences.
They also urged the need for more research to assess antibiotic susceptibility patterns and genotypic properties of infecting pathogens. IAP does not prevent EOS caused by organisms other than GBS, specifically gram-negative bacteria and does not prevent late-onset GBS disease.
“Antibiotic resistance is an urgent threat to global health,” said Flannery. “Further research is needed to understand the impact on newborns and to develop prevention and treatment strategies for antibiotic-resistant infections.”
Flannery’s work was supported by the Agency for Healthcare Research and Quality, United States (K08HS027468).
Flannery et al. “Neonatal Early-Onset Sepsis: Epidemiology, Microbiology, and Controversies in Practice.” Clinics in Perinatology. Online December 21, 2024. DOI: 10.1016/j.clp.2024.10.002
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Researchers at Children’s Hospital of Philadelphia (CHOP) recently reviewed best practices, guidelines, and care path objectives for early-onset sepsis (EOS), an invasive bacterial or fungal infection that occurs in infants within the first week of life and can be fatal. Their recommendations were recently published in Clinics in Perinatology.
Early-onset sepsis is extremely dangerous and potentially deadly to newborns. While prescribing antibiotics during labor to prevent infections in newborns has successfully reduced cases of group B streptococcus (GBS) EOS, infection rates have plateaued. At the same time, Escherichia coli EOS rates are increasing with concerning antibiotic resistance patterns. Disparities in EOS are understudied, prompting researchers to seek a better understanding of the main issues to help promote equitable care.
“Addressing gaps in the prevention and treatment of EOS is critically important to improve outcomes,” said Dustin D. Flannery, DO, MSCE, an attending physician at CHOP, and CHOP Newborn Care at Pennsylvania Hospital, and a core faculty member in Clinical Futures, a CHOP Research Institute Center of Emphasis. “Every newborn deserves an equal chance at a healthy start.”
In the paper, the authors reviewed four current controversies in neonatal EOS: the pros and cons of administering intrapartum antibiotic prophylaxis (IAP) or the practice of giving antibiotics to pregnant women before labor to prevent infection, insight into the current plateau in EOS prevention, optimal initial antimicrobial therapy and ongoing disparities in EOS.
Researchers reported that evidence-based risk assessment can aid in the identification of both term and preterm infants at higher or lower risk of EOS. They determined that ampicillin and gentamicin are the recommended routine antibiotic regimens for suspected EOS, noting that broader coverage with additional or different antibiotics may be appropriate in specific situations. The authors also stated that novel EOS prevention strategies, such as maternal vaccination, should be prioritized to prevent infections and decrease maternal and neonatal antibiotic exposures, given the associated risks of early antibiotic exposure among uninfected newborns.
Researchers underscored that providers must be aware of disparities in the prevention, screening, and treatment of neonatal EOS. They determined that further research examining racial and ethnic disparities in EOS must focus on determining the root causes for these differences.
They also urged the need for more research to assess antibiotic susceptibility patterns and genotypic properties of infecting pathogens. IAP does not prevent EOS caused by organisms other than GBS, specifically gram-negative bacteria and does not prevent late-onset GBS disease.
“Antibiotic resistance is an urgent threat to global health,” said Flannery. “Further research is needed to understand the impact on newborns and to develop prevention and treatment strategies for antibiotic-resistant infections.”
Flannery’s work was supported by the Agency for Healthcare Research and Quality, United States (K08HS027468).
Flannery et al. “Neonatal Early-Onset Sepsis: Epidemiology, Microbiology, and Controversies in Practice.” Clinics in Perinatology. Online December 21, 2024. DOI: 10.1016/j.clp.2024.10.002
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