Sehgal Rachna, Gaind Rajni, Chellani Harish, Agarwal Pushpa
Departments of Pediatrics, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
Ann Trop Paediatr. 2007 Mar;27(1):45-54. doi: 10.1179/146532807X170501.
BACKGROUND & AIMS: Multidrug-resistant extended-spectrum 3 lactamase-producing bacteria (ESBL) have emerged as a common problem globally. However, data regarding clinical profile and outcome in neonates infected with ESBL-producing gram-negative bacteria are sparse.
A retrospective study was undertaken of all neonates admitted between April 2002 and May 2003 to the neonatal intensive care unit, Safdarjang Hospital, New Delhi who had blood cultures positive for gram-negative bacteria. The clinical profile and outcome in each patient was obtained from the case notes. The mortality and morbidity of the ESBL (cases) and non-ESBL groups were compared. Data were analysed using the chi(2) and Student's t-tests.
There were 75 cases of gram-negative septicaemia, 46 newborns (61.3%) were infected with ESBL-producing strains and 63 case records were available. ESBL production was associated with prematurity (24/38 vs 9/25, p=0.03), prolonged rupture of membranes (14/38 vs 2/25, p=0.01) and previous antibiotic administration to the infant (15/38 vs 1/25, p=0.002). Fifty per cent of infants with early-onset sepsis and 82.1% with late-onset sepsis were infected with ESBL strains. Newborns with ESBL sepsis were more likely to manifest persistent thermal instability (13/38 vs 3/25, p=0.04) and pre-feed gastric aspirates (18/38 vs 3/25, p=0.004). More than 90% of ESBL isolates were susceptible to carbapenems, cefperazone-sulbactam and piperacillin-tazobactam. The mean length of nursery stay (15.8 vs 10.7, p=0.02) and mortality (23.6 vs 4.0%, p= 0.07) were higher in the ESBL group and onset of feeds was delayed (7.6 vs 3.9 days, p=0.007) in this group.
Isolation of ESBL in cases of early-onset sepsis indicates that ESBL producers might have percolated into the community. Early suspicion of ESBL-producing isolates in cases of neonatal sepsis can facilitate prompt institution of appropriate empirical therapy and lead to an improved outcome.
产超广谱β-内酰胺酶（ESBL）的多重耐药菌已成为全球普遍存在的问题。然而，关于感染产ESBL革兰阴性菌的新生儿的临床特征及预后的数据却很稀少。
对2002年4月至2003年5月入住新德里萨夫达江医院新生儿重症监护病房且血培养革兰阴性菌阳性的所有新生儿进行回顾性研究。从病历中获取每位患者的临床特征及预后情况。比较ESBL（病例组）和非ESBL组的死亡率及发病率。数据采用卡方检验和学生t检验进行分析。
共75例革兰阴性菌败血症病例，46例新生儿（61.3%）感染产ESBL菌株，63份病例记录可用。产ESBL与早产（24/38 vs 9/25，p = 0.03）、胎膜早破时间延长（14/38 vs 2/25，p = 0.01）及婴儿先前使用过抗生素（15/38 vs 1/25，p = 0.002）有关。早发型败血症患儿中有50%、晚发型败血症患儿中有82.1%感染ESBL菌株。感染ESBL败血症的新生儿更易出现持续体温不稳定（13/38 vs 3/25，p = 0.04）和喂奶前胃吸出物异常（18/38 vs 3/25，p = 0.004）。超过90%的ESBL分离株对碳青霉烯类、头孢哌酮-舒巴坦和哌拉西林-他唑巴坦敏感。ESBL组的平均住院时间（15.8 vs 10.7，p = 0.02）和死亡率（23.6% vs 4.0%，p = 0.07）更高，且该组喂奶开始时间延迟（7.6 vs 3.9天，p = 0.007）。
早发型败血症病例中分离出产ESBL表明产ESBL菌可能已传播至社区。新生儿败血症病例中早期怀疑产ESBL菌株可促进及时开始适当的经验性治疗并改善预后。
