A case-control study of early-onset E coli
sepsis compared with that of non-E coli
sepsis was conducted by a retrospective data review of all infants with a diagnosis of
sepsis during the first 7 days of life from the pediatric unit of Mackay Memorial Hospital from January 2004 to October 2008. After adjustment for gestational age, each patient with E coli early-onset
sepsis was further compared with two gestational age-matched uninfected controls.
RESULTS: Compared with infants with non-E coli
sepsis (n = 27), infants with E coli
sepsis (n = 19) were more likely to have
preterm birth, especially at less than 30 weeks of gestation (47% vs. 4%, p < 0.01), very low birth weights (<1500 g; 47% vs. 4%, p < 0.01), intrapartum
fever (26% vs. 4%, p = 0.036), preterm premature
rupture of membranes (
PPROM; 74% vs. 11%, p < 0.01), prolonged
rupture of membranes (>24 hours; 47% vs. 0%, p < 0.01),
antibiotic use (63% vs. 15%, p < 0.01), and
sepsis onset on the first day of life (63% vs. 15%, p < 0.01). After adjusting for gestational age, intrapartum
fever (26% vs. 5%, p = 0.035) and
PPROM (74% vs. 39%, p = 0.015) were more common in infants with E coli
sepsis. Fifteen of the 19 E coli isolates (79%) were
ampicillin-resistant, and three (16%) were
gentamicin-resistant. Antepartum and intrapartum
antibiotic exposure was associated with
ampicillin-resistant E coli
sepsis (100% vs. 43%, p < 0.01).
CONCLUSION: Early-onset E coli
sepsis is more common in premature and very low birth weight infants and is more likely associated with intrapartum
fever,
PPROM, and
sepsis onset on the first day of life than non-E coli
sepsis. Broad-spectrum, multiple
antibiotics or longer duration of
antibiotic exposure may be associated with
antibiotic-resistant pathogen
infection.