Stoll Barbara J, Hansen Nellie, Fanaroff Avroy A, Wright Linda L, Carlo Waldemar A, Ehrenkranz Richard A, Lemons James A, Donovan Edward F, Stark Ann R, Tyson Jon E, Oh William, Bauer Charles R, Korones Sheldon B, Shankaran Seetha, Laptook Abbot R, Stevenson David K, Papile Lu-Ann, Poole W Kenneth
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
N Engl J Med. 2002 Jul 25;347(4):240-7. doi: 10.1056/NEJMoa012657.
It is uncertain whether the rates and causes of early-onset sepsis (that occurring within 72 hours after birth) among very-low-birth-weight infants have changed in recent years, since antibiotics have begun to be used more widely during labor and delivery.
We studied 5447 very-low-birth-weight infants (those weighing between 401 and 1500 g) born at centers of the Neonatal Research Network of the National Institute of Child Health and Human Development between 1998 and 2000 who had at least one blood culture in the first three days of life and compared them with 7606 very-low-birth-weight infants born at centers in the network between 1991 and 1993.
Early-onset sepsis (as confirmed by positive blood cultures) was present in 84 infants in the more recent birth cohort (1.5 percent). As compared with the earlier birth cohort, there was a marked reduction in group B streptococcal sepsis (from 5.9 to 1.7 per 1000 live births of infants weighing 401 to 1500 g, P<0.001) and an increase in Escherichia coli sepsis (from 3.2 to 6.8 per 1000 live births, P=0.004); the overall rate of early-onset sepsis was not significantly changed. Most E. coli isolates from the recent birth cohort (85 percent) were resistant to ampicillin, and mothers of infants with ampicillin-resistant E. coli infections were more likely to have received intrapartum ampicillin than were those with ampicillin-sensitive strains (26 of 28 with sensitivity data vs. 1 of 5, P=0.01). Infants with early-onset sepsis were more likely to die than uninfected infants (37 percent vs. 13 percent, P<0.001), especially if they were infected with gram-negative organisms.
Early-onset sepsis remains an uncommon but potentially lethal problem among very-low-birth-weight infants. The change in pathogens over time from predominantly gram-positive to predominantly gram-negative requires confirmation by ongoing surveillance.
近年来，极低出生体重儿早发型败血症（出生后72小时内发生）的发病率及病因是否发生变化尚不确定，因为分娩期间抗生素的使用日益广泛。
我们研究了1998年至2000年间在美国国立儿童健康与人类发展研究所新生儿研究网络中心出生的5447例极低出生体重儿（体重401至1500克），这些婴儿在出生后的头三天至少进行了一次血培养，并将其与1991年至1993年间在该网络中心出生的7606例极低出生体重儿进行比较。
近期出生队列中有84例婴儿发生早发型败血症（血培养阳性确诊）（1.5%）。与早期出生队列相比，B组链球菌败血症显著减少（每1000例体重401至1500克的活产婴儿中，从5.9例降至1.7例，P<0.001），大肠杆菌败血症增加（每1000例活产婴儿中，从3.2例增至6.8例，P=0.004）；早发型败血症的总体发病率无显著变化。近期出生队列中大多数大肠杆菌分离株（85%）对氨苄西林耐药，感染耐氨苄西林大肠杆菌的婴儿母亲比感染氨苄西林敏感菌株的婴儿母亲更有可能在分娩期间接受氨苄西林治疗（有敏感性数据的28例中有26例，5例中有1例，P=0.01）。早发型败血症婴儿比未感染婴儿更易死亡（37%对13%，P<0.001），尤其是感染革兰氏阴性菌的婴儿。
早发型败血症在极低出生体重儿中仍然是一个不常见但潜在致命的问题。病原体随时间从主要革兰氏阳性菌向主要革兰氏阴性菌的变化需要通过持续监测来证实。
