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Bacterial pathogens in neonatal sepsis and focal neonatal infections

Bacterial pathogens in neonatal sepsis and focal neonatal infections
  Common pathogens* Some less common pathogens*
Early onset
Term and late preterm infants
(GA ≥34 weeks)
  • GBS
  • E. coli
  • Enterobacter, Enterococcus, Klebsiella, Listeria, nontypeable H. influenzae, other enteric gram-negative bacilli, S. aureus, viridans streptococci
Preterm infants
(GA <34 weeks)
  • E. coli
  • GBS
  • CoNS, Enterobacter, Klebsiella, Listeria, other enteric and nonenteric gram-negative bacilli, S. aureus, viridans streptococci
Late onset
Term and late preterm infants
(GA ≥34 weeks)
  • E. coli
  • GBS
  • Additional pathogens seen in the NICU setting – S. aureus, CoNS
  • Enterobacter, Klebsiella, Listeria, N. meningitidis, other enteric and nonenteric gram-negative bacilli, Salmonella, S. pneumoniae, viridans streptococci
  • Additional pathogens seen in the NICU setting – Citrobacter, Enterococcus, Pseudomonas, Serratia
Preterm infants
(GA <34 weeks)
  • CoNS
  • S. aureus
  • E. coli
  • Klebsiella
  • GBS
  • Citrobacter, Enterobacter, Enterococcus, Listeria, other enteric and nonenteric gram-negative bacilli, Pseudomonas, Salmonella, Serratia, viridans streptococci
Pathogens based on source of infection
Meningitis
  • GBS
  • E. coli
  • Other gram-negative enteric bacilli
  • CoNS, Enterococcus, Listeria, N. meningitides, nontypeable H. influenzae, S. aureus, S. pneumoniae, other streptococci (groups A, C, or G and viridans streptococci)
Pneumonia
  • GBS
  • C. trachomatis, Citrobacter, Enterobacter, group A Streptococcus, Klebsiella, Pseudomonas, S. aureus, S. pneumoniae, Serratia
Urinary tract infectionΔ
  • E. coli
  • Citrobacter, Enterobacter, Enterococcus, Klebsiella, Proteus
  • Additional pathogens seen in the NICU setting – CoNS, S. aureus
Skin and soft tissue infection
  • S. aureus
  • GBS
  • Group A Streptococcus
 
Vascular catheter-associated infection
  • S. aureus
  • CoNS
  • Enterococcus
  • Gram-negatives
 
Intestinal source/NEC
  • E. coli
  • Klebsiella
  • Other enteric gram-negative bacilli
  • Clostridium spp
  • Anaerobes (eg, Bacteroides)
 
GA: gestational age; GBS: group B Streptococcus; E. coli: Escherichia coli; H. influenzae: Haemophilus influenzae; S. aureus: Staphylococcus aureus; CoNS: coagulase-negative staphylococci; NICU: neonatal intensive care unit; N. meningitidis: Neisseria meningitidis; S. pneumoniae: Streptococcus pneumoniae; C. trachomatis: Chlamydia trachomatis; NEC: necrotizing enterocolitis.
* This table summarizes bacterial pathogens in neonatal sepsis and in focal neonatal infections. Common pathogens are listed roughly in order of relative frequency within each category; less common pathogens are listed alphabetically. The list of pathogens within each category is not exhaustive. This table does not address nonbacterial causes of neonatal infections (eg, herpes simplex virus, enterovirus, parechovirus, Candida). Refer to separate UpToDate content for additional information on nonbacterial pathogens.
¶ The definitions of early and late onset vary in different reports. Within UpToDate content, we generally define early onset as <7 days after birth for term infants and ≤72 hours after birth for preterm infants; however, some experts use the ≤72 hours definition regardless of GA. Late onset is generally defined as ≥7 days after birth for term infants and >72 hours after birth for preterm infants. The definitions of early and late onset as they pertain to GBS disease are somewhat different. Early-onset GBS infection typically presents within 24 hours of birth but can occur through day 6 after birth. Late-onset GBS typically occurs at 4 to 5 weeks of age.
Δ Urinary tract infections may not be associated with bacteremia in neonates.
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