Division of Child Health, St George's, University of London, London, UK.
Pediatr Infect Dis J. 2011 Oct;30(10):850-4. doi: 10.1097/INF.0b013e318224546d.
In industrialized countries, Staphylococcus aureus (SA) is a leading cause of late-onset neonatal sepsis.
Culture-proven episodes were identified prospectively from neonatal units participating in the neonatal infection surveillance network. Demographic, risk factor, and outcome data were collected.
Between 2004 and 2009, there were 117 episodes of SA infections (including 8 methicillin-resistant SA) in 116 infants from 13 units. The median gestational age and birth-weight were 27 weeks (90% ≤ 37 weeks, 85% ≤ 32 weeks) and 850 g (90% ≤ 2500 g), respectively. The overall incidence was 0.6 per 1000 live births and 23/1000 in infants <1500 g. Most episodes (94%) occurred more than 48 hours after birth (late onset). There were 7 early-onset episodes (< 48 hours) (median gestational age, 38.5 weeks), all due to methicillin-susceptible SA. At the time of culture, 67 of 95 (71%) infants were receiving respiratory support and 47 of 94 (50%) had a central line in situ. The majority of infants had nonspecific clinical features although evidence of focal infection (skin, soft tissue, bone, joint, or pneumonia) was ultimately seen in 41 of 91 (45%). There were 18 deaths, 4 (all late onset) directly due to methicillin-susceptible SA sepsis (4.4%).
SA is the second most common pathogen causing late-onset neonatal infections in this neonatal network. Infants who weigh < 1500 g in intensive care settings are the most vulnerable group. Clinical signs are not sufficiently distinctive to allow targeted therapy, suggesting that an antistaphylococcal agent should be part of empiric therapy for late-onset sepsis in premature infants.
在工业化国家，金黄色葡萄球菌（SA）是导致晚发性新生儿败血症的主要原因。
前瞻性地从参与新生儿感染监测网络的新生儿病房中确定培养证实的病例。收集人口统计学、危险因素和结局数据。
2004 年至 2009 年，在 13 个病房的 116 名婴儿中，有 117 例 SA 感染（包括 8 例耐甲氧西林 SA）。中位胎龄和出生体重分别为 27 周（90%≤37 周，85%≤32 周）和 850g（90%≤2500g）。总体发病率为每 1000 例活产儿 0.6 例，体重<1500g 的婴儿为 23/1000。大多数病例（94%）发生在出生后 48 小时以上（晚发性）。有 7 例早发性病例（<48 小时）（中位胎龄 38.5 周），均由甲氧西林敏感的 SA 引起。在进行培养时，95 例中有 67 例（71%）婴儿正在接受呼吸支持，94 例中有 47 例（50%）有中心置管。尽管 91 例中有 41 例（45%）最终出现了局灶性感染（皮肤、软组织、骨、关节或肺炎），但大多数婴儿具有非特异性的临床特征。有 18 例死亡，其中 4 例（均为晚发性）直接由甲氧西林敏感的 SA 败血症引起（4.4%）。
在这个新生儿网络中，SA 是导致晚发性新生儿感染的第二大常见病原体。在重症监护病房中体重<1500g 的婴儿是最脆弱的群体。临床症状没有足够的特征性，无法进行针对性治疗，这表明经验性治疗早产儿晚发性败血症时应使用抗葡萄球菌药物。
