Seminars in perinatology
May 13, 2026 · via Europe PMC
Neonatal early-onset sepsis: A changing paradigm of pathogens and high-risk cohorts.
Fleiss N, Bizzarro MJ.
AI summary — for doctors, generated from the abstract only
Neonatal early-onset sepsis is shifting toward aggressive, resistant Gram-negative organisms, especially E. coli, and is no longer confined to very low birth weight infants.
What was studied
A narrative review of changing pathogen epidemiology in neonatal early-onset sepsis and the high-risk cohorts affected.
Key findings
- Causative pathogens have shifted toward Gram-negative organisms over time
- The shift is attributed in part to high maternal intrapartum antibiotic exposure altering rectovaginal colonisation toward resistant organisms, with subsequent neonatal colonisation and infection
- E. coli early-onset sepsis is becoming more aggressive, resistant and difficult to treat
- Early-onset sepsis is increasingly seen in late preterm and term infants, not exclusively very low birth weight infants
Clinical relevance
This supports reviewing local early-onset sepsis pathogen and resistance patterns when setting empiric regimens, and not assuming term or late preterm infants are low risk; the review offers no comparative data on which regimen performs better.
Who should care
Limitations
Narrative review without systematic search, pooled incidence or resistance estimates, and the proposed mechanism linking intrapartum antibiotics to resistant neonatal infection is inferential.
Do not assume early-onset sepsis means GBS in a tiny baby; resistant E. coli in term infants is the growing problem.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
The causative pathogens of neonatal early-onset sepsis (EOS) have changed over time with a shift towards gram-negative organisms. This change is likely multifactorial and due in part to a high prevalence of maternal intrapartum antibiotic exposure leading to alterations in rectovaginal colonization with antibiotic-resistant organisms and subsequent neonatal colonization and infection. As a result, neonatal EOS secondary to gram-negative pathogens, particularly Escherichia coli (E. coli), is becoming more aggressive, resistant and difficult to treat, and not exclusive to very low birth weight infants with more EOS emerging in late preterm and term infants. Therefore, a heightened awareness regarding the dangers of resistant bacterial infections in neonates is critical, as well as a reevaluation of current maternal and neonatal surveillance and prevention efforts.
DOI
10.1016/j.semperi.2026.152248
PMID
42128693
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed