Early-onset neonatal sepsis and neonatal antibiotic exposure in Hungary a nationwide population-based study.

چکیده اصلی

UNLABELLED: Neonatal sepsis remains a challenge in perinatal medicine. We aimed to estimate incidence of culture positive early-onset sepsis (CP-EOS), causative pathogens and overall antibiotic exposure in newborn infants in Hungary. Retrospective national registry analysis (2020-2023). Data were mainly collected from the Hungarian National Perinatal Registry covering all level II-III neonatal intensive care units (NICUs) in Hungary. The number of livebirths in each gestational age group was provided by Hungarian Central Statistical Office. Overall CP-EOS incidence was 0.41/1,000 livebirths (0.20/1,000 ≥ 35 weeks gestation, 7.0/1,000 < 35 weeks gestation). Main pathogens were Escherichia coli (33.3%) and Group B streptococci -GBS (24.5%). Ten of 49 (20.4%) infants with E. coli sepsis died. No GBS related mortality occurred. Lumbar puncture was only performed in 30/147 (20.4%) of the CP-EOS cases. No cases of isolated meningitis occurred in the absence of CP-EOS. Newborns presenting with respiratory distress in the first 72 h were five times more likely to receive antibiotics (OR 4.9 CI 4.6-5.2) than infants without respiratory distress. Overall, 63.9% of NICU-treated neonates received antibiotics for a median (IQR) duration of 5 (3-8) days. A minimum of 3.2% of all neonates in Hungary received antibiotics, acknowledging that some more neonates are treated on postnatal wards and Level I NICUs which are not included in the perinatal registry. A substantial number (15.6%) of blood cultures were taken without subsequent antibiotic commencement. CONCLUSIONS: Our results provide the first national incidence estimates for CP-EOS in Central-Eastern Europe. The study identified high antibiotic use with a concurrently relatively low EOS incidence. The results support implementing new strategies to reduce unnecessary antibiotic exposure in the newborn period. WHAT IS KNOWN: • Neonatal early-onset sepsis (EOS) causes substantial neonatal morbidity, prompting widespread, frequent empirical antibiotic use. • Unnecessary early-life antibiotic exposure shifts the infant gut microbiota and increases risks for long-term adverse health outcomes. WHAT IS NEW: • This first nationwide Central-Eastern European study reveals a low EOS incidence (0.41/1,000 live births) but high NICU antibiotic exposure (63.9%) in Hungary. • Escherichia coli has overtaken GBS as the leading EOS pathogen, causing significant mortality primarily in preterm infants.

ترجمه فارسی چکیده

هدف این مطالعه برآورد شیوع عفونت‌های زودرس ناشی از کشت مثبت (CP-EOS)، عوامل عفونی‌کننده و مواجهه کلی با آنتی‌بیوتیک در نوزادان در مجارستان بود. این مطالعه تحلیل رکورد ملی بازگشت‌پذیر (۲۰۲۰-۲۰۲۳) بود. شیوع کلی CP-EOS 0.41/۱۰۰۰ تولد زنده بود. عوامل اصلی عفونی‌کننده عبارت بودند از E. coli (۳۳.۳٪) و گاردنللا استرپتوکوک گروپ B (GBS) (۲۴.۵٪). ۱۰ از ۴۹ نوزاد مبتلا به عفونت E. coli فوت کردند. نمونه‌برداری نخاعی فقط در ۳۰ مورد (۲۰.۴٪) انجام شد. ۶۳.۹٪ نوزادان تحت درمان در یونیت مراقبت‌های ویژه نوزاد (NICU) آنتی‌بیوتیک دریافت کردند. حداقل ۳.۲٪ از تمام نوزادان آنتی‌بیوتیک دریافت کردند. ۱۵.۶٪ نمونه‌برداری خون انجام شد بدون شروع آنتی‌بیوتیک.

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