Fw: PRO/EDR> E. coli infection, perinatal - USA

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Interesting...... e ----- Original Message ----- From: ProMED-mail Sent: Thursday, July 25, 2002 8:26 PM promed-edr@... Subject: PRO/EDR> E. coli infection, perinatal - USA E. COLI INFECTION, PERINATAL - USA*******************************A ProMED-mail post<http://www.promedmail.org>ProMED-mail, a program of theInternational Society for Infectious Diseases<http://www.isid.org>Date: Thu, 25 Jul 2002 04:49:57 -0700From: Pablo Nart <p.nart@...>Source: Source Nando Times, 24 July 2002 [edited]<http://www.nandotimes.com/healthscience/story/477044p-3811510c.html>E. coli infection rise among premature babies-------------------------------In a dangerous effect apparently caused by antibiotics, _E. coli_ is on therise among premature babies and has overtaken strep as the mostcommon infection in such infants, a new study suggests.The shift is worrisome because _E. coli_ bacterial may be more deadlythan those due to the kind of streptococcus found in newborns.The rate of group B streptococcal bloodstream infections in newborn preemiesfell by nearly three-quarters during the 1990s, probably because more womenin labor now get antibiotics to keep from passing the bacteria on to theirbabies during delivery, the researchers said.During that same period, the rate of _E. coli_ infections doubled,apparently because ampicillin, the antibiotic commonly used toeradicate the streptococcus, gave _E. coli_ a survival advantage,according to the researchers. [Many _E. coli_ are ampicillinsensitive, 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 publishedin the 25 July 2002 issue of the New England Journal of Medicine. It was ledby Dr. Barbara J.Stoll, professor of pediatrics at Emory University Schoolof Medicine in Atlanta, Georgia, USA.Group B strep and _E. coli_ are among the bacteria that liveharmlessly in many people's intestinal tract as well as the femalegenital tract. Over the last decade, giving women preventiveantibiotics intravenously during labor has cut the once-predominantgroup B strep infections by 70 per cent in all newborns, but it stillkills about 80 infants each year.NIH scientists and doctors at about a dozen hospitals and medical schoolscompared 5 447 very low-birth-weight infants born from 1998 through 2000with 7 606 similar births from 1991 through 1993. Very low-birth-weight wasdefined 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 commontype 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 to1.7 per 1 000 births. The overall rate of sepsis dropped from 19.3 per1 000 births to 15.4 per 1 000 births. [The overall rates of mortality andsignificant residual morbidity are also important variables not reported.-Mod.LL]Since 1996, the CDC, the American Academy of Pediatrics and the AmericanCollege of Obstetricians and Gynecologists have backed 2 strategies asequally effective for deciding which mothers should get antibiotics duringlabor to prevent group B streptococcal neonatal infection.One involves testing mothers for presence of streptococcus in the vaginanear the end of the pregnancy; the other recommends antibiotics for allmothers who have risk factors linked to transmission of the bacteria: afever above 100 degrees, preterm delivery or rupture of the protectiveamniotic membrane 18 hours or more before delivery.In a study published in the same issue of the Journal, the first studycomparing the approaches, researchers found that testing for streptococcuscut the risk of a baby being infected 54 per cent more than the risk-factorapproach."While the risk-factor approach is definitely catching some women, it'smissing a good proportion of women," said Stefanie J. Schrag, a CDCepidemiologist.As a result, the CDC in August will release new guidelines recommendingscreening all women for presence of group B strep, she said. The researchersstudied records on 5 144 babies born at about 170 hospitals around thecountry.--ProMED-mail<promed@...>[it would be interesting to see if the same shift in neonatal infectionpathogens would be seen in term babies. If we assume that the _E.coli_ isolated in the study were ampicillin resistant, it would alsobe interesting to know if the resistance package carried over toother antimicrobials that might be chosen as empiric choices forneonatal sepsis presentations. -Mod.LL][it has been feared that the use of intrapartum antibiotics, sosuccessful in reducing the incidence of group B streptococcalinfection in neonates, would lead to infections with more resistantorganisms. This major study documents just such a phenomenon. Anaccompanying editorial calls for the use of vaccines that would belikely to reduce group B streptococcal infection without selection ofresistant bacteria and would eliminate the need to expose a largenumber of women to antibiotics with the attendant risks ofanaphylaxis or other adverse reactions. Such vaccines are now beingdeveloped and tested in clinical trials. -Mod.LM][see also:2001--Group B strep infections - Norway: 1986-2000 20011006.24221997--Strep. Group B, perinatal infection - USA 19970929.2059]................................ll/lm*##########################################################*ProMED-mail makes every effort to verify the reports thatare posted, but the accuracy and completeness of theinformation, and of any statements or opinions basedthereon, are not guaranteed. The reader assumes all risks inusing information posted or archived by ProMED-mail. 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