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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.

Section 3. Summaries of Infectious Diseases

Escherichia coli and Other Gram-Negative Bacilli

(Septicemia and Meningitis in Neonates)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Neonatal septicemia or meningitis caused by Escherichia coli and other gram-negative bacilli cannot be differentiated clinically from serious infections caused by other infectious agents. The first signs of sepsis may be subtle and similar to those observed in noninfectious processes. Clinical signs of septicemia include fever, temperature instability, grunting respirations, apnea, cyanosis, lethargy, irritability, anorexia, vomiting, jaundice, hepatomegaly, abdominal distention, and diarrhea. Meningitis may occur without overt signs suggesting central nervous system involvement. Some gram-negative bacilli, such as Citrobacter koseri, Enterobacter sakazakii, and Serratia marcescens, are associated with brain abscesses in infants with meningitis caused by these organisms.


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ETIOLOGY: Escherichia coli strains with the K1 capsular polysaccharide antigen cause approximately 40% of cases of septicemia and 80% of cases of meningitis caused by E coli. Other important gram-negative bacilli causing neonatal septicemia include non-K1 strains of E coli, Klebsiella, Enterobacter, Proteus, Citrobacter, Salmonella, Pseudomonas, and Serratia species. Nonencapsulated strains of Haemophilus influenzae; Streptococcus pneumoniae; group A, C, or G streptococci; Neisseria meningitidis; and anaerobic gram-negative bacilli are rare causes.


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EPIDEMIOLOGY: The source of E coli and other gram-negative bacterial pathogens in neonatal infections usually is the maternal genital tract. In addition, nosocomial acquisition of gram-negative organisms through person-to-person transmission among nursery personnel and from nursery environmental sites, such as sinks, multiple-use solutions, and countertops, has been documented, especially in preterm infants who require prolonged intensive care management. Predisposing factors in neonatal gram-negative bacterial infections include maternal intrapartum infections, gestation <37 weeks, low birth weight, prolonged rupture of membranes, and traumatic delivery. Metabolic abnormalities, such as galactosemia, fetal hypoxia, and . . . [Go to Full Text]


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Infection Control for Hospitalized Children
Red Book 2003 2003: 146-155. [Extract] [Full Text]