Managing Escherichia coli sepsis and the Tarragona strategy

Early onset sepsis is one of the leading causes of neonatal death – worldwide as well as in high-resource countries (1). The incidence (2) of early-onset sepsis and the case fatality rate (3) are even higher among preterm infants, in whom a shift towards gram-negative bacteria, predominantly Escherichia coli, occurs (4). For life-threatening diseases, empiric antibiotic therapy regimens must cover the most relevant pathogens and, at the same time, avoid any unnecessary use of reserve antibiotics (5, 6). In most cases of early-onset neonatal sepsis, the pathogens colonizing the neonate or its previous environment, the mother’s womb, are not known when treatment is initiated.