Cordero L, Sananes M, Ayers L W
Newborn Services, the Department of Pediatrics, The Ohio State University Medical Center, Columbus, OH 43210-1228, USA.
Am J Infect Control. 2000 Aug;28(4):286-90. doi: 10.1067/mic.2000.106845.
Gram-negative bacillary (GNB) airway colonization in mechanically ventilated newborns is associated with morbidity and mortality, which may be reduced if systemic antimicrobial therapy eradicates GNB from the airway. Efforts to do so in adults have met with variable success; similar experiences in newborns have not been reported.
From 1991 through 1998, 531 very low-birth-weight infants were mechanically ventilated longer than 2 weeks. The study group was 106 infants with GNB airway colonization. Sixty-four other neonates in whom GNB nosocomial bloodstream infections developed served as antibiotic treatment outcome control.
Isolated from the airway were enteric (70 cases) and environmental (36 cases) GNB. Gentamicin alone or with ceftazidime (79), ceftazidime (11), piperacillin in combination with tazobactam or tobramycin (8), and tobramycin, in combination with ampicillin/sulbactam or mezlocillin (8) were the antimicrobials selected. Systemic antibiotics failed to eradicate GNB colonization in 97% of the cases. Six of the 106 infants with airway colonization died for reasons unrelated to infection. Sixty-four infants experienced 67 bloodstream infections as a result of enteric (53) and environmental (14) GNB. Gentamicin alone (23), with ceftazidime (26), or with clindamycin or ampicillin/sulbactam (9), piperacillin with tazobactam or tobramycin (3) and ceftazidime alone (6) were the antimicrobials selected. Survival occurred in 84% of the 67 nosocomial bloodstream infections.
Systemic antibiotics do not consistently eradicate GNB from the airway of mechanically ventilated newborns, therefore its empirical use for prophylaxis or treatment of airway colonization should be discouraged.
机械通气新生儿的革兰氏阴性杆菌（GNB）气道定植与发病率和死亡率相关，如果全身抗菌治疗能从气道清除GNB，则可能降低发病率和死亡率。在成人中为此所做的努力取得了不同程度的成功；新生儿中的类似经验尚未见报道。
1991年至1998年，531例极低出生体重儿接受机械通气超过2周。研究组为106例有GNB气道定植的婴儿。另外64例发生GNB医院血流感染的新生儿作为抗生素治疗结果对照。
从气道分离出肠道（70例）和环境（36例）GNB。选用的抗菌药物有单独使用庆大霉素或与头孢他啶联用（79例）、头孢他啶（11例）、哌拉西林联合他唑巴坦或妥布霉素（8例）以及妥布霉素联合氨苄西林/舒巴坦或美洛西林（8例）。全身抗生素未能在97%的病例中清除GNB定植。106例气道定植婴儿中有6例因与感染无关的原因死亡。64例婴儿因肠道（53例）和环境（14例）GNB发生了67次血流感染。选用的抗菌药物有单独使用庆大霉素（23例）、与头孢他啶联用（26例）或与克林霉素或氨苄西林/舒巴坦联用（9例）、哌拉西林与他唑巴坦或妥布霉素联用（3例）以及单独使用头孢他啶（6例）。67次医院血流感染中有84%存活。
全身抗生素不能始终从机械通气新生儿气道清除GNB，因此不鼓励经验性使用其预防或治疗气道定植。
