Marzban Asghar, Samaee Hadi, Mosavinasab Noredien
Department of Pediatrics, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Acta Med Iran. 2010 Sep-Oct;48(5):312-5.
Bacterial sepsis is one of the most common causes of mortality and morbidity in neonates. It has been recognized a gradual change in spectrum of organisms responsible for neonatal sepsis. In this study we have evaluated changing trend of incidence and antibiotic susceptibility in neonatal late - onset sepsis (LOS) in 2-periods. This study is based on results of blood culture in neonatal late-onset sepsis, in 2--periods study throughout 12 - years. Neonatal LOS was defined as clinical signs suggestive of infection with a positive blood culture (B/C) after 72 hrs of birth. During first study (period: 1990-1992), the most common bacteremia in LOS was staphylococcus aureus (staph aureus) (34%). Overall gram- negative bacteria (GNB) were the predominant organism (66%). It was shown that 60% of GNB were resisted to gentamicin and 3% to amikacin, while in case of gram-positive bacteria (GPB); about 95% were resisted to ampicillin and 28% to cephalothin. In the second study (period: 2004-2007), the vast majority (56.6%) of septic cases were caused by GNB. The most common cause of late- onset sepsis was klebsiela p. (31%). The GPB were resistant to cephalothin (90%). There has been a dramatic increase resistance to cephalothin and aminoglycosides and 3rd -generation cephalosporins. The combination of cephalothin plus amikacin in suspected LOS was no longer the effective therapeutic regimen in our neonatal intensive care unit (NICU). Now, it seems the best choice for empiric antibiotic regimen in suspected LOS is the combination vancomycin plus amikacin. Constant surveillance is important to guide empirical antibiotic therapy and changes in trends.
细菌败血症是新生儿死亡和发病的最常见原因之一。人们已经认识到，导致新生儿败血症的病原体谱在逐渐变化。在本研究中，我们评估了两个时期新生儿晚发性败血症（LOS）的发病率变化趋势和抗生素敏感性。本研究基于一项为期12年的两个时期的新生儿晚发性败血症血培养结果。新生儿LOS定义为出生72小时后出现提示感染的临床体征且血培养（B/C）呈阳性。在第一项研究（时期：1990 - 1992年）中，LOS中最常见的菌血症是金黄色葡萄球菌（34%）。总体而言，革兰氏阴性菌（GNB）是主要病原体（66%）。结果显示，60%的GNB对庆大霉素耐药，3%对阿米卡星耐药，而革兰氏阳性菌（GPB）方面，约95%对氨苄西林耐药，28%对头孢噻吩耐药。在第二项研究（时期：2004 - 2007年）中，绝大多数（56.6%）败血症病例由GNB引起。晚发性败血症最常见的原因是肺炎克雷伯菌（31%）。GPB对头孢噻吩耐药（90%）。对头孢噻吩、氨基糖苷类和第三代头孢菌素的耐药性显著增加。在我们的新生儿重症监护病房（NICU），头孢噻吩加阿米卡星联合用药已不再是疑似LOS的有效治疗方案。现在，对于疑似LOS的经验性抗生素治疗方案，似乎最佳选择是万古霉素加阿米卡星联合用药。持续监测对于指导经验性抗生素治疗和趋势变化很重要。
