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Abstract：
BACKGROUND: Early-onset neonatal sepsis (EONS) significantly impacts neonatal morbidity and mortality, with maternal bacteremia during the peripartum period being a potential risk factor. This study aims to explore the association between peripartum maternal bacteremia and EONS.
METHODS: A retrospective cohort study at the Women\'s Wellness and Research Center in Doha, Qatar (2015-2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS.
RESULTS: Among the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 - 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 - 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 - 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 - 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 - 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 - 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 - 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 - 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates.
CONCLUSIONS: This study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.
METHODS: A retrospective cohort study at the Women\'s Wellness and Research Center in Doha, Qatar (2015-2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS.
RESULTS: Among the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 - 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 - 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 - 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 - 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 - 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 - 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 - 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 - 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates.
CONCLUSIONS: This study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.
摘要：
背景：早发性新生儿败血症（EONS）显著影响新生儿发病率和死亡率，围产期产妇菌血症是一个潜在的危险因素。本研究旨在探讨围产期产妇菌血症与EONS之间的关系。
方法：多哈妇女健康与研究中心的一项回顾性队列研究，卡塔尔（2015-2019）比较有和没有菌血症的女性，根据分娩前七天至分娩后48小时的血培养，检查与EONS的联系。
结果：在分析的536个母体血液培养物中，102（19.0%）为阳性。最流行的生物是B组链球菌（GBS）（39.2％），其次是大肠杆菌(14.7%)和厌氧菌(10.8%)。来自菌血症母亲的新生儿出生体重较低（2913±86gvs.3140±745g；MD227.63g；95%CI61.72-393.55；p=0.007），需要更多的复苏(27.5%vs.13.2%；OR2.48；95%CI1.48-4.17；p<0.001），并更频繁地接受抗生素治疗≥7天(41.2%vs.16.6％；OR3.51；95％CI2.20-5.62；p<0.001）与非菌血症母亲相比。与革兰氏阴性（GN）（22.2％）和厌氧菌血症（9.9％）相比，在足月妊娠中分离出母体革兰氏阳性（GP）生物（67.9％）更为常见。在产时,GP菌血症占主导地位（67.1％）GN（21.4％）和厌氧菌（11.4％），GN菌血症在产后样本中更为常见。经过文化验证的EONS发生在队列的0.75％，影响3.9%的婴儿从菌血症的母亲与对照组无一例(OR2.34；95%CI1.27-4.31；p<0.001)。培养阴性EONS出现在14.7％的菌血症母亲婴儿中，与对照组为7.8%（OR2.02；95%CI，1.05-3.88；p=0.03）。40例GBS菌血症产妇中,经培养证实的GBSEONS发生在3名新生儿(7.5%)中，所有来自GBS筛查阴性的母亲，与对照组无相比。发现EONS与任何生物体引起的母体菌血症之间存在强烈关联（aOR2.34；95％CI，1.24-4.41；p=0.009），GP菌血症（aOR3.66；95%CI，1.82-7.34；p<0.001），或GBS（aOR5.74；95%CI，2.57-12.81；p<0.001）。GN和厌氧生物引起的菌血症与EONS无关。绒毛膜羊膜炎和产前发热是与重要细菌分离株相关的EONS的独立预测因子。
结论：这项研究强调了孕产妇GP菌血症的显着影响，特别是来自GBS，在EONS上。这种强烈的关联凸显了对并发菌血症的妊娠进行警惕监测和干预的必要性，以减少不良的新生儿结局。
方法：多哈妇女健康与研究中心的一项回顾性队列研究，卡塔尔（2015-2019）比较有和没有菌血症的女性，根据分娩前七天至分娩后48小时的血培养，检查与EONS的联系。
结果：在分析的536个母体血液培养物中，102（19.0%）为阳性。最流行的生物是B组链球菌（GBS）（39.2％），其次是大肠杆菌(14.7%)和厌氧菌(10.8%)。来自菌血症母亲的新生儿出生体重较低（2913±86gvs.3140±745g；MD227.63g；95%CI61.72-393.55；p=0.007），需要更多的复苏(27.5%vs.13.2%；OR2.48；95%CI1.48-4.17；p<0.001），并更频繁地接受抗生素治疗≥7天(41.2%vs.16.6％；OR3.51；95％CI2.20-5.62；p<0.001）与非菌血症母亲相比。与革兰氏阴性（GN）（22.2％）和厌氧菌血症（9.9％）相比，在足月妊娠中分离出母体革兰氏阳性（GP）生物（67.9％）更为常见。在产时,GP菌血症占主导地位（67.1％）GN（21.4％）和厌氧菌（11.4％），GN菌血症在产后样本中更为常见。经过文化验证的EONS发生在队列的0.75％，影响3.9%的婴儿从菌血症的母亲与对照组无一例(OR2.34；95%CI1.27-4.31；p<0.001)。培养阴性EONS出现在14.7％的菌血症母亲婴儿中，与对照组为7.8%（OR2.02；95%CI，1.05-3.88；p=0.03）。40例GBS菌血症产妇中,经培养证实的GBSEONS发生在3名新生儿(7.5%)中，所有来自GBS筛查阴性的母亲，与对照组无相比。发现EONS与任何生物体引起的母体菌血症之间存在强烈关联（aOR2.34；95％CI，1.24-4.41；p=0.009），GP菌血症（aOR3.66；95%CI，1.82-7.34；p<0.001），或GBS（aOR5.74；95%CI，2.57-12.81；p<0.001）。GN和厌氧生物引起的菌血症与EONS无关。绒毛膜羊膜炎和产前发热是与重要细菌分离株相关的EONS的独立预测因子。
结论：这项研究强调了孕产妇GP菌血症的显着影响，特别是来自GBS，在EONS上。这种强烈的关联凸显了对并发菌血症的妊娠进行警惕监测和干预的必要性，以减少不良的新生儿结局。
