Pediatrics. 2012 May;129(5):1006-15. doi: 10.1542/peds.2012-0541. Epub 2012 Apr 30.
With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis.
随着产科管理水平的提高和产时抗菌药物应用的循证医学证据不断增加，早发型新生儿败血症的发病率逐渐降低。然而，早发型败血症仍然是早产儿发病率和死亡率的最常见原因之一。早发型败血症风险新生儿的识别通常基于一系列围产期危险因素，但这些危险因素既不敏感也不特异。此外，新生儿败血症的诊断检测具有较差的阳性预测准确性。因此，临床医生经常对表现良好的婴儿进行长时间的治疗，即使细菌培养结果为阴性。疑似早发型败血症婴儿的最佳治疗方法是广谱抗菌药物（氨苄西林和氨基糖苷类）。一旦确定病原体，就应缩小抗菌治疗范围（除非需要协同作用）。最近的数据表明，早产儿（≥5 天）接受广谱抗生素经验性治疗时间延长与晚发型败血症、坏死性小肠结肠炎和死亡率升高之间存在关联。为了降低这些风险，在败血症可能性低的临床情况下，应在 48 小时内停止抗菌治疗。本临床报告的目的是提供一种实用的、在可能的情况下基于循证医学证据的方法，用于管理疑似或确诊的早发型败血症婴儿。
