Antibiotic resistance is rising in invasive E coli found in US newborns, study finds

News brief
Topics
Antimicrobial Stewardship
E coli
Newborn in incubator
Sviatlana Lazarenka / iStock

An analysis of invasive Escherichia coli samples from newborns at a US pediatric hospital found rising rates of resistance to recommended antibiotics, researchers reported today in Open Forum Infectious Diseases.

For the study, researchers from the University of Missouri-Kansas City School of Medicine and Children’s Mercy Hospital Kansas City identified and analyzed E coli isolated from blood cultures of newborns at the hospital from 2006 to 2021. E coli is a major neonatal pathogen in the United States, and leading cause of sepsis in newborns. The researchers wanted to investigate the clinical characteristics of newborns with E coli bacteremia (bacteria in the blood), and the pattern of antibiotic resistance in E coli isolates over time.

“This knowledge is crucial to develop effective preventative and treatment strategies for this devastating disease,” the researchers wrote.

Ongoing surveillance needed

Of the 54 newborns identified with E coli bacteremia, seven developed early-onset sepsis (within 72 hours of birth or less), 12 were treated for E coli meningitis, and two had necrotizing enterocolitis. Five of the newborns died, including three who were born preterm. The mortality rate was 19% in preterm newborns versus 5% for term newborns.

Antibiotic susceptibility analysis found 54% of E coli isolates overall were nonsusceptible to ampicillin and 11% were nonsusceptible to gentamicin—the two antibiotics recommended for first-line treatment in newborns with sepsis—with ampicillin nonsusceptibility rising from 46% to 61% between 2006-2013 and 2014-2021. The percentage of isolates that were nonsusceptible to cefazolin, an alternative therapy, rose from 8% to 36%. 

Whole genome sequencing revealed the most prominent E coli sequence types (STs) were ST95 (17%), ST69 (11%), and ST131 (7%), and 43% of isolates contained the K1 capsule, which plays a crucial role in disease progression. 

The authors say ongoing surveillance of resistance in larger US populations is needed to help clinicians select effective antibiotic regimens in newborns with sepsis. 

“Understanding genomic traits and molecular epidemiology trends of neonatal E. coli invasive strains is also crucial to develop novel preventative and treatment strategies that are urgently needed,” they wrote.

Infant formula voluntarily recalled after testing positive for heat-stable toxin

News brief
Topics
Foodborne Disease

Infant formula sold on Amazon and at Meijer stores has been voluntarily recalled by the New Zealand-based a2 Milk Company.

Tin of a2 platinum premium infant formula.
CDC

Though the Food and Drug Administration (FDA) reports "no confirmed incidents of illness or harm have been reported," the agency wants people to dispose of imported a2 Platinum Premium USA label infant formula 0-12 months with the following batch numbers: 2210269454, 2210324609, 2210321712.

The recall was reportedly initiated after cereulide, a toxin, was detected through additional testing in accordance with guidance recently issued by New Zealand's food regulatory authority.

"The recall is isolated to the USA label Product, which has a different formulation and relevant ingredient to the English label a2 Platinum infant formula sold in Australia, New Zealand, South Korea, Vietnam and through cross border channels into China,” the company said in a press release.

The a2 formula was imported during Operation Fly Formula, according to the company and FDA. The 2022 initiative used government planes and personnel to accelerate shipments of infant formula during a national shortage in the United States. The FDA reports that a total of 16,428 affected tins were sold and that the product was discontinued prior to the recall.

Recent rash of cereulide contamination 

Cereulide is produced by certain strains of the bacterium Bacillus cereus. The toxin is heat-stable so boiling water will not destroy it. 

The World Health Organization (WHO) says the symptoms of cereulide illness usually appear within 30 minutes to six hours after ingestion. It can include nausea, vomiting, and abdominal pain with risk of dehydration and electrolyte imbalance, which can be particularly severe in infants.

From December 2016 to February 2026, at least 99 countries and territories have received infant formula products that were subject to recalls because of cereulide contamination. The WHO said in a March 13 press release that at least 144 suspected and confirmed cases were reported across 10 countries.

"The full root cause analysis and complete traceability of all affected batches remains under investigation," said the international health agency. 

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