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Published Date: 2002-07-25 23:50:00
Subject: PRO/EDR> E. coli infection, perinatal - USA
Archive Number: 20020725.4862

E. COLI INFECTION, PERINATAL - USA
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Date: Thu, 25 Jul 2002 04:49:57 -0700
From: Pablo Nart <p.nart@virgin.net>
Source: Source Nando Times, 24 July 2002 [edited]
<http://www.nandotimes.com/healthscience/story/477044p-3811510c.html>

E. coli infection rise among premature babies
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In a dangerous effect apparently caused by antibiotics, _E. coli_ is on the
rise among premature babies and has overtaken strep as the most
common infection in such infants, a new study suggests.
The shift is worrisome because _E. coli_ bacterial may be more deadly
than those due to the kind of streptococcus found in newborns.
The rate of group B streptococcal bloodstream infections in newborn preemies
fell by nearly three-quarters during the 1990s, probably because more women
in labor now get antibiotics to keep from passing the bacteria on to their
babies during delivery, the researchers said.
During that same period, the rate of _E. coli_ infections doubled,
apparently because ampicillin, the antibiotic commonly used to
eradicate the streptococcus, gave _E. coli_ a survival advantage,
according to the researchers. [Many _E. coli_ are ampicillin
sensitive, although not stated here, it is presumed that the _E.
coli_ that persisted were ampicillin resistant. -Mod.LL]
The study was funded by the National Institutes of Health and was published
in the 25 July 2002 issue of the New England Journal of Medicine. It was led
by Dr. Barbara J.Stoll, professor of pediatrics at Emory University School
of Medicine in Atlanta, Georgia, USA.
Group B strep and _E. coli_ are among the bacteria that live
harmlessly in many people's intestinal tract as well as the female
genital tract. Over the last decade, giving women preventive
antibiotics intravenously during labor has cut the once-predominant
group B strep infections by 70 per cent in all newborns, but it still
kills about 80 infants each year.
NIH scientists and doctors at about a dozen hospitals and medical schools
compared 5 447 very low-birth-weight infants born from 1998 through 2000
with 7 606 similar births from 1991 through 1993. Very low-birth-weight was
defined as 3 1/2 pounds or less.
Over the study, the gram-negative type of bacteria,predominantly _E. coli_,
overtook group B streptococcus and other related bacteria as the most common
type of infection in the premies.
_E. coli_ infections rose from 3 per 1 000 births to 7 per 1 000 births,
while group B streptococcal infections dropped from 5.9 per 1 000 births to
1.7 per 1 000 births. The overall rate of sepsis dropped from 19.3 per
1 000 births to 15.4 per 1 000 births. [The overall rates of mortality and
significant residual morbidity are also important variables not reported.
-Mod.LL]
Since 1996, the CDC, the American Academy of Pediatrics and the American
College of Obstetricians and Gynecologists have backed 2 strategies as
equally effective for deciding which mothers should get antibiotics during
labor to prevent group B streptococcal neonatal infection.
One involves testing mothers for presence of streptococcus in the vagina
near the end of the pregnancy; the other recommends antibiotics for all
mothers who have risk factors linked to transmission of the bacteria: a
fever above 100 degrees, preterm delivery or rupture of the protective
amniotic membrane 18 hours or more before delivery.
In a study published in the same issue of the Journal, the first study
comparing the approaches, researchers found that testing for streptococcus
cut the risk of a baby being infected 54 per cent more than the risk-factor
approach.
"While the risk-factor approach is definitely catching some women, it's
missing a good proportion of women," said Stefanie J. Schrag, a CDC
epidemiologist.
As a result, the CDC in August will release new guidelines recommending
screening all women for presence of group B strep, she said. The researchers
studied records on 5 144 babies born at about 170 hospitals around the
country.
--
ProMED-mail
<promed@promedmail.org>
[It would be interesting to see if the same shift in neonatal infection
pathogens would be seen in term babies. If we assume that the _E.
coli_ isolated in the study were ampicillin resistant, it would also
be interesting to know if the resistance package carried over to
other antimicrobials that might be chosen as empiric choices for
neonatal sepsis presentations. -Mod.LL]
[It has been feared that the use of intrapartum antibiotics, so
successful in reducing the incidence of group B streptococcal
infection in neonates, would lead to infections with more resistant
organisms. This major study documents just such a phenomenon. An
accompanying editorial calls for the use of vaccines that would be
likely to reduce group B streptococcal infection without selection of
resistant bacteria and would eliminate the need to expose a large
number of women to antibiotics with the attendant risks of
anaphylaxis or other adverse reactions. Such vaccines are now being
developed and tested in clinical trials. -Mod.LM]

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