TOPLINE

A nationwide registry study in Hungary found that culture-confirmed early-onset sepsis was rare, affecting 0.41 of every 1000 live births from 2020 to 2023, and nearly two thirds of newborn infants admitted to NICUs received antibiotics.

METHODOLOGY

• Researchers conducted a retrospective, population-based study using national registry data to estimate the incidence of culture-positive early-onset sepsis among infants born in Hungary from 2020 to 2023.
• They included 20,652 infants admitted to level 2 and 3 NICUs (mean gestational age, 34.7 weeks; 55% boys).
• Culture-positive early-onset sepsis was defined as the isolation of a disease-causing organism from the blood within 72 hours of birth, together with planned treatment with systemic antibiotics for more than 5 days or death attributed to the infection.
• The primary outcome was the incidence of culture-positive early-onset sepsis overall and by gestational age (≥ 35 vs < 35 weeks).
• Secondary outcomes were the pathogens causing sepsis, the frequency of antibiotic use among infants, and the duration of treatment.

TAKEAWAY

• Culture-positive early-onset sepsis occurred in 147 infants (incidence, 0.41 per 1000 live births), with 0.20 per 1000 among infants born at 35 weeks of gestation or later and 7.0 per 1000 among those born before 35 weeks.
• All infants with sepsis received antibiotics. Antibiotics were also given to 63.6% of admitted infants without sepsis for a median of 5 days.
• Infants with respiratory distress had nearly fivefold higher odds of receiving antibiotics than those without (odds ratio, 4.9; 95% CI, 4.6-5.2).
• Escherichia coli (33.3%) and group B streptococci (24.5%) were the most common causes of culture-positive early-onset sepsis. Group B streptococci were the leading cause among infants born at 35 weeks or later (37.3%), whereas E coli was the most common cause among those born before 35 weeks (43.8%).

IN PRACTICE

"Coordinated national efforts to standardize clinical practice and promote evidence-based antibiotic stewardship are needed to reduce the substantial and potentially avoidable antibiotic exposure observed in this vulnerable population," the authors wrote.

SOURCE

The study was led by Judit Mari, University of Szeged, Szeged, Hungary. It was published online on October 02, 2026, in the European Journal of Pediatrics.

LIMITATIONS

The study relied on registry and administrative data, so the findings may have been affected by information bias and misclassification of cases. Data from level 1 neonatal units and postnatal wards were not captured, which likely led to an underestimation of antibiotic use. The registry did not record exactly when antibiotics were started or stopped, laboratory test results, or how bacteria responded to the antibiotics.

DISCLOSURES

The authors did not report any specific funding for the study and declared no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.