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Ten-Year Study on the Effect of Intrapartum Antibiotic Prophylaxis on Early Onset Group B Streptococcal and Escherichia coli Neonatal Sepsis in Australasia

Daley, Andrew J. MBBS, FRACP, FRCPA*; Isaacs, David MD, FRACP, FRCPCH†; and the Australasian Study Group for Neonatal Infections

Pediatric Infectious Disease Journal:
Original Studies

Background: Intrapartum antibiotics have reduced the incidence of neonatal early onset (EO) group B streptococcal (GBS) disease. Some surveillance data suggest that this success may be at the cost of increasing rates of non-GBS infection, especially in premature neonates.

Objective: To examine rates of EOGBS infection and EO Escherichia coli neonatal sepsis in Australasia.

Methodology: Analysis of trends in EO (<48 h age) GBS and E. coli sepsis from longitudinal prospective surveillance data collected from representative tertiary obstetric hospitals in each state of Australia and selected centers in New Zealand during a 10-year period from 1992 through 2001. Statistical analysis used Poisson regression.

Results: 206 GBS and 96 E. coli cases occurred in 298,319 live births during the study period. The EOGBS sepsis rate fell from a peak of 1.43/1000 live births in 1993 to 0.25/1000 in 2001 (P < 0.001). The overall EO E. coli sepsis rate was 0.32/1000. In babies with birth weight <1500 g, it was 6.20/1000. There was an overall trend to decreasing EO E. coli sepsis (P = 0.07), and there was no significant change in E. coli sepsis in babies <1500 g (P = 0.60). Sixty-nine percent of E. coli cases occurred in the <1500 g cohort; the case fatality rate in this group was 50%. The overall case fatality rate from E. coli sepsis was 36%, and this rate remained stable during the study period (P = 0.47).

Conclusions: The increasing use of intrapartum antibiotics produced a steady decline in EOGBS disease in Australasia. There was also a trend to decreasing EO E. coli sepsis in all babies, and the rate in very low birth weight infants remained stable.

Author Information

Accepted for publication February 25, 2004.

Address for reprints: Dr. Andrew Daley, Department of Microbiology and Infectious Diseases, Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia. Fax 61 3 9345 5764; E-mail

© 2004 Lippincott Williams & Wilkins, Inc.