Chiu Shun, Huang Yhu-Chering, Lien Rey-In, Chou Yi-Hong, Lin Tzou-Yien
Division of Pediatric Infectious Diseases, Chang Gung University, Taoyuan, Taiwan.
Acta Paediatr. 2005 Nov;94(11):1644-9. doi: 10.1080/08035250510037704.
To determine the risk factors for the acquisition of nosocomial extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infection in infants hospitalized in neonatal intensive care units (NICUs) and to evaluate the therapeutic outcome of these infants.
We retrospectively reviewed the medical records of infants with nosocomial ESBL-producing Enterobacteriaceae infection hospitalized in NICUs at Chang Gung Children's Hospital in 2001. The clinical features of these infants were compared with a cohort of non-ESBL-producing Enterobacteriaceae-infected infants during the same period. The therapeutic outcome of the infants in the ESBL group was analysed.
Seventy infants were included in this study. Thirty-one infants with 34 isolates were identified in the ESBL group and 39 infants with 42 isolates in the non-ESBL group. Of the parameters analysed, including gestational age, birthweight, length of hospital stay before onset, the number of antibiotics used, the duration of third-generation cephalosporin usage and the number of patients receiving a third-generation cephalosporin prior to the onset of infection, no significant difference was found between the two groups. The infection-contributed case fatality rate was 3.0% (1 of 33) in the ESBL group, not significantly different from that in the non-ESBL group (1 of 41, 2.4%). Of the 31 patients in the ESBL group, 18 were treated with a carbapenem as definitive therapy while 13 were treated with a non-carbapenem antibiotic regimen. No significant difference was noted in terms of mortality rate between the two subgroups.
The outcome of the infants hospitalized in the NICU with ESBL-producing enterobacterial infections was not indispensably grave, even when treated with a non-carbapenem antibiotic regimen. The risk factors for the acquisition of ESBL-producing enterobacterial infections in these infants were not identified in this series.
确定新生儿重症监护病房（NICU）住院婴儿获得产超广谱β-内酰胺酶（ESBL）肠杆菌科细菌感染的危险因素，并评估这些婴儿的治疗结果。
我们回顾性分析了2001年在长庚儿童医院NICU住院的产ESBL肠杆菌科细菌医院感染婴儿的病历。将这些婴儿的临床特征与同期非产ESBL肠杆菌科细菌感染的婴儿队列进行比较。分析ESBL组婴儿的治疗结果。
本研究共纳入70例婴儿。ESBL组有31例婴儿，分离出34株菌株；非ESBL组有39例婴儿，分离出42株菌株。在所分析的参数中，包括胎龄、出生体重、发病前住院时间、使用抗生素的数量、第三代头孢菌素使用时间以及感染发作前接受第三代头孢菌素治疗的患者数量，两组之间均未发现显著差异。ESBL组感染导致的病死率为3.0%（33例中的1例），与非ESBL组（41例中的1例，2.4%）无显著差异。ESBL组的31例患者中，18例接受碳青霉烯类药物作为确定性治疗，13例接受非碳青霉烯类抗生素方案治疗。两个亚组的死亡率无显著差异。
即使采用非碳青霉烯类抗生素方案治疗，NICU住院的产ESBL肠杆菌感染婴儿的预后并非必然严重。本系列研究未确定这些婴儿获得产ESBL肠杆菌感染的危险因素。
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