Biran V, Gaudin A, Mariani-Kurdjian P, Doit C, Bingen E, Aujard Y
Service de Réanimation et Pédiatrie Néonatales, AP-HP, Hôpital Robert Debré, 48, Boulevard Sérurier, 75019 Paris, France.
Arch Pediatr. 2010 Sep;17 Suppl 4:S150-3. doi: 10.1016/S0929-693X(10)70917-9.
The objective of this study was to determine the incidence of extended-spectrum beta-lactamase (ESBLS) enterobacteriaceae colonization and infection in hospitalized children.
This prospective study was conducted in a neonatal intensive care unit from 2000 to 2009. We recorded all isolations of ESBLs enterobacteriaceae from clinical samples that were obtained from hospitalized children. Anorectal samples were taken at admission and every 10 days. We systematically recorded cases of confirmed infections that was caused by ESBLs enterobacteriacea.
A total of 46 ESBL(S) pathogens (E coli 58.7 %, Enterobacter cloacae 10.8 %, Klebsiella Pneumonia 19.5%, K. oxytoca 6.5 %, Citrobacter 4.5 %) were isolated during 10 years, the global incidence was 5.1 cases per 1000 admissions. Three infants developed nosocomial infections, E. coli sepsis and pneumonia and Enterobacter cloacae omphalitis. These patients were treated with carbapenem with significant clinical improvement. ESBLs enterobacteriaceae were found first in Klebsiella pneumonia and then predominantly in E. coli. Current efforts have focused on monitoring proper hand hygiene, evaluation of potential reservoirs of bacterial acquisition and transmission, cohorting and isolation of colonized infants, and fostering of effective inter- and intrahospital communication. Carbapenem seems to be safe in newborn and is recommended for the treatment of EBLSEs enterobacteriaceae infections.
本研究的目的是确定住院儿童中产超广谱β-内酰胺酶（ESBLS）肠杆菌科细菌定植和感染的发生率。
这项前瞻性研究于2000年至2009年在新生儿重症监护病房进行。我们记录了从住院儿童临床样本中分离出的所有ESBLs肠杆菌科细菌。入院时及每10天采集一次直肠拭子样本。我们系统地记录了由ESBLs肠杆菌科细菌引起的确诊感染病例。
在10年期间共分离出46株产ESBL（S）病原体（大肠杆菌58.7%，阴沟肠杆菌10.8%，肺炎克雷伯菌19.5%，产酸克雷伯菌6.5%，枸橼酸杆菌4.5%），总体发病率为每1000例入院患者中有5.1例。3名婴儿发生了医院感染，分别为大肠杆菌败血症、肺炎和阴沟肠杆菌脐炎。这些患者接受了碳青霉烯治疗，临床症状有显著改善。ESBLs肠杆菌科细菌首先在肺炎克雷伯菌中发现，然后主要在大肠杆菌中发现。目前的工作重点是监测正确的手部卫生、评估细菌获取和传播的潜在储存源、对定植婴儿进行分组和隔离，以及促进有效的医院间和医院内沟通。碳青霉烯类药物在新生儿中似乎是安全的，推荐用于治疗产ESBLs肠杆菌科细菌感染。
