Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Glasgow, UK.
Aliment Pharmacol Ther. 2011 Oct;34(8):1005-11. doi: 10.1111/j.1365-2036.2011.04826.x. Epub 2011 Aug 28.
Long-term parenteral nutrition has transformed the prognosis for children suffering from intestinal failure. However, parenteral nutrition itself is associated with considerable morbidity and mortality including that caused by sepsis.
To examine a strategy of cycled enteral antibiotics in reducing the incidence of sepsis in paediatric intestinal failure patients.
Retrospective analysis of the incidence of sepsis rates of patients on long-term parenteral nutrition, at a tertiary paediatric hospital. Patients were separated into those who received cycled enteral antibiotics and a control group. Sepsis rates before and during cycled enteral antibiotics were compared with comparable timeframes between the cycled enteral antibiotics and control groups. Central venous catheter removal rates were also compared.
Fifteen patients (eight cycled enteral antibiotics, & seven controls) received 9512 parenteral nutrition days, with a total of 132 sepsis episodes. All eight patients of the treatment group demonstrated a decrease in the frequency of episodes of sepsis following the introduction of cycled enteral antibiotics. The cycled enteral antibiotics group had a significant reduction in infection rate during the treatment period (from 2.14 to 1.06 per 100 parenteral nutrition days, P = 0.014: median effect size -1.04 CI 95%-1.93, -0.22), whereas the controls had no significant change (1.91 - 2.36 per 100 parenteral nutrition days P = 0.402: median effect size 0.92 CI 95%-1.96, 4.17). The central venous catheter survival rates increased in the cycled enteral antibiotics group from 0.44 central venous catheter removals per 100 parenteral nutrition days to 0.27 central venous catheter removals per 100 parenteral nutrition days, although this was not statistically significant.
Cycled enteral antibiotics significantly reduced the rate of sepsis in a small group of paediatric intestinal failure patients. Larger well-designed prospective studies are warranted to further explore this finding.
长期肠外营养改变了患有肠衰竭的儿童的预后。然而，肠外营养本身会导致相当高的发病率和死亡率，包括败血症引起的发病率和死亡率。
研究周期性肠内抗生素在降低儿科肠衰竭患者败血症发病率中的作用。
回顾性分析一家三级儿科医院长期肠外营养患者的败血症发生率。将患者分为接受周期性肠内抗生素和对照组。比较两组患者在使用周期性肠内抗生素前后及同期的败血症发生率。还比较了中心静脉导管拔除率。
15 例患者（8 例接受周期性肠内抗生素治疗，7 例对照组）接受了 9512 天的肠外营养，共有 132 例败血症发作。治疗组的所有 8 例患者在引入周期性肠内抗生素后，败血症发作的频率均有所降低。治疗期间，周期性肠内抗生素组的感染率显著降低（从每 100 天肠外营养 2.14 次降至 1.06 次，P = 0.014：中位数效应大小-1.04 CI 95%-1.93，-0.22），而对照组无显著变化（每 100 天肠外营养 1.91-2.36 次，P = 0.402：中位数效应大小 0.92 CI 95%-1.96，4.17）。虽然无统计学意义，但周期性肠内抗生素组中心静脉导管的存活率从每 100 天肠外营养 0.44 次导管拔除率增加至每 100 天肠外营养 0.27 次导管拔除率。
在一小部分儿科肠衰竭患者中，周期性肠内抗生素显著降低了败血症的发生率。需要进行更大规模、设计更合理的前瞻性研究来进一步探讨这一发现。
