Alarcon Ana, Peña Pilar, Salas Sofia, Sancha Marta, Omeñaca Felix
Division of Neonatology, Department of Pediatrics, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Pediatr Infect Dis J. 2004 Apr;23(4):295-9. doi: 10.1097/00006454-200404000-00004.
Although intrapartum antimicrobial prophylaxis has lowered the incidence of early onset group B Streptococcus (GBS) sepsis, there are concerns that the increased use of antibiotics may raise the incidence of non-GBS antimicrobial-resistant infections. The objective of this study was to determine trends in the incidence and antimicrobial resistance of early onset sepsis caused by Escherichia coli in the era of antimicrobial prophylaxis.
All neonates with early onset E. coli infection who were born at La Paz Hospital, Madrid, from January 1, 1992, through December 31, 2002, were identified from a microbiologic register of all neonatal infections. To evaluate the effect of the guidelines for GBS prevention, data were pooled and compared for: 1992 through 1995 (Period 1); 1996 through 1998 (Period 2); and 1999 through 2002 (Period 3).
Early onset E. coli infection was diagnosed in 41 of 84 612 live births. The infection rate did not change significantly during the 3 time periods (0.56, 0.24 and 0.55 per 1000 during Periods 1, 2 and 3, respectively; P = 0.936, linear-by-linear association). The proportion of E. coli infections that were resistant to ampicillin increased significantly among preterm infants, from 25% (1 of 4) in Period 1, to 100% (2 of 2) in Period 2 and to 91% (10 of 11) in Period 3 (P = 0.017, linear-by-linear association), but not among term infants, with 67% (8 of 12) in Period 1, 50% (1 of 2) in Period 2 and 44% (4 of 5) in Period 3 (P = 0.317, linear-by-linear association).
Although the incidence of early onset sepsis caused by E. coli remained stable during the study period, antibiotic-resistant E. coli infections increased among preterm infants. On the whole these trends are reassuring with respect to GBS prophylaxis. However, the increase in the proportion of ampicillin-resistant infections in preterm infants suggests that continuing evaluation of the risks and benefits of prophylaxis in this group is critical.
尽管产时抗菌药物预防已降低了早发型B族链球菌（GBS）败血症的发病率，但人们担心抗生素使用的增加可能会提高非GBS耐药感染的发病率。本研究的目的是确定抗菌药物预防时代早发型大肠杆菌败血症的发病率和抗菌药物耐药性趋势。
从所有新生儿感染的微生物登记册中识别出1992年1月1日至2002年12月31日在马德里拉巴斯医院出生的所有早发型大肠杆菌感染新生儿。为了评估GBS预防指南的效果，将数据汇总并比较以下三个时间段：1992年至1995年（第1阶段）；1996年至1998年（第2阶段）；以及1999年至2002年（第3阶段）。
84612例活产中有41例被诊断为早发型大肠杆菌感染。在这三个时间段内感染率没有显著变化（第1、2和3阶段分别为每1000例0.56、0.24和0.55例；P = 0.936，线性关联）。在早产儿中，对氨苄西林耐药的大肠杆菌感染比例显著增加，从第1阶段的25%（4例中的1例）增加到第2阶段的100%（2例中的2例）和第3阶段的91%（11例中的10例）（P = 0.017，线性关联），但足月儿中没有显著变化，第1阶段为67%（12例中的8例），第2阶段为50%（2例中的1例），第3阶段为44%（5例中的4例）（P = 0.317，线性关联）。
尽管在研究期间早发型大肠杆菌败血症的发病率保持稳定，但早产儿中耐抗生素大肠杆菌感染有所增加。总体而言，这些趋势对于GBS预防是令人放心的。然而，早产儿中氨苄西林耐药感染比例的增加表明，持续评估该组预防的风险和益处至关重要。
