Bacteriemias verticales: ¿tratar o no tratar?

Résumé

Objective To analyze the incidence, etiology and management of infants born in 1977 with vertically transmitted bacteriemia or suspected early onset neonatal sepsis. Patients and methods The total number of newborn infants in this period was 2,365. We revised the clinical histories of the infants diagnosed with bacteriemia and classified them into two groups: a) those with vertically transmitted bacteriemias, according to the recommendations of the Castrillo Group, and b) those with suspected early onset neonatal sepsis in whom blood culture was positive and analytical data suggested bacterial infection but who showed no clinical symptoms of vertically transmitted sepsis. Birthweight, sex, gestational age, risks factors for neonatal infection, clinical signs and laboratory tests suggestive of bacterial infection and microbiological agents were analyzed. The clinical and analytical evolution of the treated and untreated newborn infants was studied. Results Ten newborn infants were diagnosed with vertically transmitted bacteriemia (an incidence of 4.2 × 1,000 live newborn infants) and 17 were diagnosed with suspected early onset neonatal sepsis (7.8 × 1,000 live newborns). All the infants had risk factors for neonatal sepsis. The most common of these was prolonged membrane rupture (≥ 18 hours) due to which sepsis screening was carried out (hemogram, C-reactive protein at 12 and 36-48 hours of life, and blood culture). In both groups the most commonly isolated microorganism was group B streptococcus, which was found in 30 % of vertically transmitted bac-teriemias and in 41.2 % of suspected early onset neonatal sepsis. All the newborn infants with suspected sepsis and two with vertically transmitted bacteriemia were treated without incident. The remaining eight infants with untreated vertically transmitted bacteremia were followed-up clinically and analytically for one year, and remained asymptomatic. Conclusions The most common microorganism in vertically transmitted bacteriemia and suspected early onset neonatal sepsis was group B streptococcus. None of the untreated infants developed late sepsis or meningitis. Our findings suggest that non-treatment of asymptomatic infants with vertically transmitted bacteriemias is appropriate as long as close clinical surveillance is maintained.