La rete di sorveglianza delle infezioni da streptococco beta-emolitico di gruppo B in Emilia Romagna

NESSUN ABSTRAC

The network of surveillance of infections streptococcal B in Emilia-Romagna: Prevention of early infections [La rete di sorveglianza delle infezioni da Streptococco B nella Regione Emilia-Romagna: Prevenzione delle infezioni precoci]

Prospective area based study of group B Streptococcus infections Background Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis in newborns Intrapartum administration of antibiotics to GBS colonized mothers reduces the rate of early-onset disease. Objectives To promote a common prevention strategy in an Italian region, to analyze clinical findings, trends of disease incidence and factors which determine the persistence of the disease. Methods Prospective, area-based study, during a 6 years period; all delivery units and regional laboratories involved in the study. Results A screening-based strategy was adopted by centres. The incidence of earlyonset disease was low with respect to European countries; most of residual cases were associated with the culture detection failure of organisms at 35-37 weeks of gestation. Meningitis was much more common among infants with late-onset disease. Both, early- and late-onset infections had no significant variations of disease incidence during the 6 years study period. Conclusions Prevention strategies reduced the rate and the severity of early-infections. Most residual cases were due to the culture detection failure of organisms at antenatal screening; additional efforts are therefore required to implement the strategy

The burden of early-onset sepsis in Emilia-Romagna (Italy): a 4-year, population-based study

Objective: To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS. Methods: Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed. Results: Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight <1000 g (20.37/1000 LB and 8.49/1000 LB, respectively). The most common pathogens were GBS (n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coli EOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%). Conclusions: GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate