Possible Rates of Detection of Neonatal Sepsis Pathogens in the Context of Microbiological Diagnostics in Mothers – Real World Data

Abstract

Objective

The aim of this study was to identify the rate of detection of neonatal sepsis pathogens in maternal microbiological smears.

Study Design

This is a retrospective study conducted at a Level 1 perinatal center in the context of routine care from 2014 to 2019. For all premature infants and neonates with neonatal sepsis, the neonatal and maternal microbiological findings were examined to see if there was a match.

Results

During the study period, a total of 948 premature or newborn infants were identified as having a neonatal infection. Among all of the premature or newborn infants, 209 (22%) met the diagnostic criteria for neonatal sepsis; of these, 157 were premature births and 52 were full-term births. We evaluated the microbiological findings for these 209 mother and child pairs. No pathogens were detected in 27 out of 157 mothers of premature infants (17.1%) and in 31 out of 52 mothers of full-term infants (59.6%). In the premature infant group there were pairs with matching pathogens in 30 out of 130 cases (23.1%, 95% CI: 16.1–31.3), and in the full-term infant group there was a match in 4 out of 21 cases (19%, 95% CI: 5.4–41.9). The number needed to test to have a 90% probability of success for pathogen detection varies between 9 and 11 in the most favorable case and 26 and 32 in the least favorable case, depending on the evaluation method.

Conclusion

In cases of neonatal sepsis, the sepsis-causing pathogen was successfully detected through prior analysis of a maternal smear in 7% of full-term infants and in 19% of premature infants. The number needed to test was relatively high in all groups. The value of maternal smears for identifying neonatal sepsis-causing pathogens needs to be critically questioned.

Keywords

bacterial infection - infections - premature birth - pregnancy - normal birth

Publication History

Received: 13 February 2023

Accepted after revision: 07 May 2023

Article published online:
21 June 2023

• References/Literatur

• 1 Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr 2016; 28: 135-140 DOI: 10.1097/MOP.0000000000000315.
• 2 Sharma D, Farahbakhsh N, Shastri S. et al. Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med 2018; 31: 1646-1659 DOI: 10.1080/14767058.2017.1322060.
• 3 Puopolo KM, Lynfield R, Cummings JJ. et al. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics 2019; 144: e20191881 DOI: 10.1542/peds.2019-1881.
• 4 Buhimschi IA, Nayeri UA, Laky CA. et al. Advances in medical diagnosis of intra-amniotic infection. Expert Opin Med Diagn 2013; 7: 5-16 DOI: 10.1517/17530059.2012.709232.
• 5 Odabasi IO, Bulbul A. Neonatal Sepsis. Sisli Etfal Hastan Tip Bul 2020; 54: 142-158 DOI: 10.14744/SEMB.2020.00236.
• 6 Rathore H, Rahman AJ, Salman M. et al. Frequency of early-onset neonatal sepsis following prolonged rupture of membranes. Cureus 2020; 12: e6864 DOI: 10.7759/cureus.6864.
• 7 Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017; 390: 1770-1780 DOI: 10.1016/S0140-6736(17)31002-4.
• 8 Randis TM, Rice MM, Myatt L. et al. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med 2018; 46: 926-933 DOI: 10.1515/jpm-2017-0192.
• 9 Wortham JM, Hansen NI, Schrag SJ. et al. Chorioamnionitis and culture-confirmed, early-onset neonatal infections. Pediatrics 2016; 137: e20152323 DOI: 10.1542/peds.2015-2323.
• 10 Hanna M, Noor A. Streptococcus group B. StatPearls Treasure Island (FL): StatPearls Publishing; 2022
• 11 Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease. 2010 Accessed June 12, 2022 at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm
• 12 Glaser MA, Hughes LM, Jnah A. et al. Neonatal sepsis: A review of pathophysiology and current management strategies. Adv Neonatal Care 2021; 21: 49-60 DOI: 10.1097/ANC.0000000000000769.
• 13 Simonsen KA, Anderson-Berry AL, Delair SF. et al. Early-Onset Neonatal Sepsis. Clin Microbiol Rev 2014; 27: 21-47 DOI: 10.1128/CMR.00031-13.
• 14 Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion, Number 797. Obstet Gynecol [Anonym]. 2020; 135: e51 DOI: 10.1097/AOG.0000000000003668.
• 15 Schrag SJ, Farley MM, Petit S. et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics 2016; 138: e20162013 DOI: 10.1542/peds.2016-2013.
• 16 Boyer KM, Gotoff SP. Prevention of early-onset meonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. N Engl J Med 1986; 314: 1665-1669 DOI: 10.1056/NEJM198606263142603.
• 17 Schilling AL, Rody A, Bossung V. Antibiotic use during pregnancy and childbirth: prospective observational study on prevalence, indications, and prescribing patterns in a German tertiary center. Geburtshilfe Frauenheilkd 2022; 83: 192-200 DOI: 10.1055/a-1934-1761.
• 18 Randis TM, Polin RA, Saade G. Chorioamnionitis: time for a new approach. Curr Opin Pediatr 2017; 29: 159-164 DOI: 10.1097/MOP.0000000000000466.
• 19 Goldenberg RL, Culhane JF, Iams JD. et al. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84 DOI: 10.1016/S0140-6736(08)60074-4.
• 20 Klein LL, Gibbs RS. Infection and Preterm Birth. Obstet Gynecol Clin North Am 2005; 32: 397-410 DOI: 10.1016/j.ogc.2005.03.001.
• 21 Abou-Dakn M, Schäfers R, Peterwerth N. et al. Vaginal birth at term – Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82: 1143-1193 DOI: 10.1055/a-1904-6546.
• 22 Abou-Dakn M, Schäfers R, Peterwerth N. et al. Vaginal birth at term – Part 2. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82: 1194-1248 DOI: 10.1055/a-1904-6769.
• 23 Berger R, Abele H, Bahlmann F. et al. Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/025, September 2022) – Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth. Geburtshilfe Frauenheilkd 2023; 83: 547-568 DOI: 10.1055/a-2044-0203.
• 24 Berger R, Abele H, Bahlmann F. et al. Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, September 2022) – Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and on the Management of Preterm Premature Rupture of Membranes. Geburtshilfe Frauenheilkd 2023; 83: 569-601 DOI: 10.1055/a-2044-0345.
• 25 Thomson A. The Royal College of Obstetricians and Gynaecologists. Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation. BJOG 2019; 126: e152-e166 DOI: 10.1111/1471-0528.15803.
• 26 Di Renzo GC, Melin P, Berardi A. et al. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med 2015; 28: 766-782 DOI: 10.3109/14767058.2014.934804.
• 27 Eschborn S, Weitkamp J-H. Procalcitonin versus C-reactive protein: review of kinetics and performance for diagnosis of neonatal sepsis. J Perinatol 2019; 39: 893-903 DOI: 10.1038/s41372-019-0363-4.
• 28 Keij FM, Kornelisse RF, Tramper-Stranders GA. et al. Improved pathogen detection in neonatal sepsis to boost antibiotic stewardship. Future Microbiol 2020; 15: 461-464 DOI: 10.2217/fmb-2019-0334.
• 29 Morris JM, Roberts CL, Bowen JR. et al. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet 2016; 387: 444-452 DOI: 10.1016/S0140-6736(15)00724-2.
• 30 Özenci V, Schubert U. Earlier and more targeted treatment of neonatal sepsis. Acta Paediatr 2019; 108: 169-170 DOI: 10.1111/apa.14597.
• 31 Giannon E, Agyeman PKA, Stocker M. et al. Neonatal sepsis of early onset, and hospital-acquired and community-acquired late onset: a prospective population-based cohort study. J Pediatr 2018; 201: 106-114.e4 DOI: 10.1016/j.jpeds.2018.05.048.
• 32 Stoll BJ, Puopolo KM, Hansen NI. et al. Early-onset neonatal sepsis 2015 to 2017, the rise of escherichia coli, and the need for novel prevention strategies. JAMA Pediatr 2020; 174: e200593 DOI: 10.1001/jamapediatrics.2020.0593.
• 33 Iroh Tam P-Y, Bendel CM. Diagnostics for neonatal sepsis: current approaches and future directions. Pediatr Res 2017; 82: 574-583 DOI: 10.1038/pr.2017.134.
• 34 Franz A, Härtel C, Herting E. et al. Prophylaxe der Neugeborenensepsis – frühe Form – durch Streptokokken der Gruppe B. Leitlinie des BVF, BVDfK, der DGGG, DGHM, DGPI, DGPM und GNPI. (S2k-Level, AWMF-Registernummer 024/020, März 2016). Z Geburtshilfe Neonatol 2017; 221: 122-129 DOI: 10.1055/s-0043-105207.
• 35 Polin RA, Papile L-A. the Committee on Fetus and Newborn. et al. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012; 129: 1006-1015 DOI: 10.1542/peds.2012-0541.
• 36 Bennett PR, Brown RG, MacIntyre DA. Vaginal microbiome in preterm rupture of membranes. Obstet Gynecol Clin North Am 2020; 47: 503-521 DOI: 10.1016/j.ogc.2020.08.001.
• 37 Brown AP, Denison FC. Selective or universal screening for GBS in pregnancy (review). Early Hum Dev 2018; 126: 18-22 DOI: 10.1016/j.earlhumdev.2018.09.002.
• 38 Ramesh Babu S, McDermott R, Farooq I. et al. Screening for group B Streptococcus (GBS) at labour onset using PCR: accuracy and potential impact – a pilot study. J Obstet Gynaecol 2018; 38: 49-54 DOI: 10.1080/01443615.2017.1328490.
• 39 Benitz WE, Achten NB. Technical assessment of the neonatal early-onset sepsis risk calculator. Lancet Infect Dis 2021; 21: e134-e140 DOI: 10.1016/S1473-3099(20)30490-4.
• 40 Achten NB, Klingenberg C, Benitz WE. et al. Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety. JAMA Pediatr 2019; 173: 1032-1040 DOI: 10.1001/jamapediatrics.2019.2825.
• 41 Kuzniewicz MW, Walsh EM, Li S. et al. Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates. Jt Comm J Qual Patient Saf 2016; 42: 232-239 DOI: 10.1016/S1553-7250(16)42030-1.
• 42 Escobar GJ, Puopolo KM, Wi S. et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks’ gestation. Pediatrics 2014; 133: 30-36 DOI: 10.1542/peds.2013-1689.