Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention JOSE ´ B. LO ´ PEZ SASTRE, BELEN FERNA ´ NDEZ COLOMER, GILAN D. COTO COTALLO, ANTONIO RAMOS APARICIO & “GRUPO DE HOSPITALES CASTRILLO” 1 Service of Neonatology, Department of Paediatrics, Hospital Central de Asturias, Oviedo, Spain Abstract Aim: To assess trends in the epidemiology of culture-proven and clinical neonatal sepsis of vertical transmission in the era of intrapartum antibiotic prophylaxis. Methods: Since 1995, the neonatal services of 28 acute-care teaching hospitals in Spain (“Grupo de Hospitales Castrillo”) have been involved in the prospective surveillance of neonatal infection of vertical trans- mission. We here report the comparison of the incidence for the periods 1996–1997 and 2000–2001, and look separately at two groups of hospitals according to the time at which the official hospital policy to provide intrapartum antibiotic prophylaxis for group B Streptococcus (GBS) prevention was adopted. In 16 hospitals the policy was adopted in 1999 and in 10 before 1998 (nine hospitals in 1996, one in 1997). Results: The incidence of proven sepsis decreased significantly by 22% and 54% in the hospitals that started prophylaxis in 1999 and before 1998, respectively. The incidence of GBS sepsis also declined signifi- cantly by 36.4% and 65.4% in both groups of hospitals, respectively. Significant variations in the incidence of clinical vertical sepsis as well as in the incidence of sepsis caused by Haemophilus influenzae and Klebsiella were not found. Sepsis caused by Escherichia coli increased in the hospitals with prophylaxis from 1999 and decreased in those that began prophylaxis before 1998, in which the mortality rate of proven and clinical sepsis also decreased significantly by 58.6%. Conclusions: There was a substantial decline in the incidence of proven vertical sepsis, with a significant reduction of GBS sepsis, although decreases were more marked when antibiotic prophylaxis was started before 1998. In this group of hospitals, there was also a decrease in the mortality rate. Fluctuations in the incidence of E. coli infection suggest the need for continuing epidemiological surveillance. Key Words: Group B Streptococcus, intrapartum antibiotic prophylaxis, neonatal sepsis, newborn infants, vertical transmission Introduction Neonatal sepsis of vertical transmission remains an important problem associated with high morbidity and mortality rates in newborns [1]. Infection of the fetus results from the ascending spread of pathogens from the vagina of a colonized mother who is typically asymptomatic, or during passage through the birth canal [2]. Group B Streptococcus (GBS), or Strepto- coccus agalactiae, is the leading cause of serious vertical sepsis and meningitis [1,3–6]. Clinical trials in the mid-1980s demonstrated that antibiotic prophylaxis administered during labour to mothers colonized with group B streptococci was highly effective in preventing the disease in newborns [7]. In 1996, consensus guidelines for the prevention of perinatal group strepto- coccal disease were issued by the American College of Obstetricians and Gynecologists, the American Correspondence: J. Lo ´pez Sastre, Servicio de Neonatologı ´a, Hospital Central de Asturias, Celestino Villamil s/n, E-33006 Oviedo, Asturias, Spain. Tel: +34 985 108000/108066. Fax: +34 985 108066. E-mail: jlopezs@ya.com and bcolomer@arrakis.es 1 Members of “Grupo de Hospitales Castrillo”: J. M. Fraga Bermu ´dez and J. R. Ferna ´ndez Lorenzo, Hospital General de Galicia, Santiago de Compostela; R. Reparaz Vidal, Hospital Juan Canalejo, La Corun ˜ a; I. Fidalgo A ´ lvarez, Hospital del Bierzo, Ponferrada; E. A ´ lvaro Iglesias, Complejo Hospitalario de Leo ´n; M. P. Arago ´ n Garcı ´a, Hospital Clı ´nico and C. Gonza ´lez Armengod, Hospital del Rı ´o Hortega, Valladolid; M. C. Pedraz Garcı ´a, Hospital Clı ´nico, Salamanca; A. Urbo ´ n Artero, Hospital de la Seguridad Social, Segovia; P. Aparicio Lozano, Hospital General Yagu ¨ e, Burgos; A. Cotero Lavı ´n, Hospital de Cruces, Bilbao; L. Paisa ´n Grisolı ´a, Hospital Nuestra Sen ˜ ora de Ara ´nzazu, San Sebastia ´n; A. Marco Tello, Hospital Miguel Servet and J. Pe ´rez Gonza ´lez, Hospital Clı ´nico, Zaragoza; A. Belaustegui Cueto and C. de Alba Romero, Hospital Doce de Octubre, M. Moro Serrano, Hospital Clı ´nico San Carlos, M. Sa ´nchez Luna, Hospital Gregorio Maran ˜o ´ n, and S. Salas Herna ´ndez, Hospital La Paz, Madrid; S. Salcedo Abizanda, Hospital Vall d’Hebro ´ , X. Carbonell Estrany and J. Figueras Aloy, Hospital Clı ´nic y Casa Maternitat, X. Krauel Vidal and M. Iriondo Sanz, Hospital Sant Joan de De ´u, and R. Baraibar Castello ´ , Institut Universitari Dexeus, Barcelona; V. Roque ´s Serradilla, Hospital La Fe ´, Valencia; J. Ortiz Tardı ´o, Hospital de la Seguridad Social, Jerez de la Frontera; M. Garcı ´a del Rı ´o, Hospital Materno Infantil-Clı ´nico Universitario, Ma ´laga; M. Samaniego Mun ˜ oz, Hospital Virgen de las Nieves and E. Narbona Lo ´ pez, Hospital Clı ´nico, Granada; and E. Dome ´nech Martı ´nez, Hospital Clı ´nico Santa Cruz de Tenerife, Spain. (Received 25 September 2003; revised 29 March 2004 and 30 August 2004; accepted 16 September 2004) Acta Pædiatrica, 2005; 94: 451–457 ISSN 0803-5253 print/ISSN 1651-2227 online # 2005 Taylor & Francis Group Ltd DOI: 10.1080/08035250410025302