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Observational Study
. 2019 Dec 12;19(1):490.
doi: 10.1186/s12887-019-1866-z.

Changes in incidence and etiology of early-onset neonatal infections 1997-2017 - a retrospective cohort study in western Sweden

Margrét Johansson Gudjónsdóttir  1   2 , Anders Elfvin  3   4 , Elisabet Hentz  3   4 , Ingegerd Adlerberth  5 , Ingemar Tessin  3   4 , Birger Trollfors  3   4
Affiliations
Observational Study

Changes in incidence and etiology of early-onset neonatal infections 1997-2017 - a retrospective cohort study in western Sweden

Margrét Johansson Gudjónsdóttir et al. BMC Pediatr. .

Abstract

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.

Keywords: EARLY ONSET; EPIDEMIOLOGY; MENINGITIS; NEONATAL SEPSIS.

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Conflict of interest statement

None of the authors have any financial or non-financial competing interests.

Figures

Fig. 1
Fig. 1
Flow chart over number of neonates included and excluded in the study
Fig. 2
Fig. 2
Age at onset of early-onset invasive infection according to organisms isolated from blood and/or cerebrospinal fluid among 209 neonates during the first 7 days of life between 1997 and 2017
Fig. 3
Fig. 3
Changes in Incidence per 1000 live births of Early-Onset Invasive Infections caused by Group B Streptococcus, Staphylococcus aureus and aerobic Gram-negative rods between 1975 and 2017
See this image and copyright information in PMC

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