Predictors of Mortality and Severe Illness from Escherichia coli Sepsis in Neonates

Abstract Background: Neonatal Escherichia coli (E. coli) sepsis is increasing. There is limited data on the factors which contribute to increased mortality and severity of illness in neonatal E. colisepsis. Methods: Retrospective review of neonates (<30 days) admitted to a Level IV NICU in the United States from 2008 to 2022 with a diagnosis of E. coli bloodstream or cerebrospinal fluid infection was conducted. Primary outcome was defined as mortality from or severe illness during E. coliinfection (defined as need for inotropic support or metabolic acidosis). Results: E. coli neonatal sepsis rate increased from 2008-2022 (average of 1.12 per 1,000 live births). The primary outcome, which occurred in 50% of cases, was independently associated with prematurity, neutropenia, and thrombocytopenia. Ampicillin resistance was not associated with the primary outcome. Conclusion: GA, neutropenia, and thrombocytopenia but not ampicillin resistance, are associated with mortality or severe illness from E. colisepsis.