Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina 27710, USA.
Curr Opin Pediatr. 2013 Apr;25(2):167-71. doi: 10.1097/MOP.0b013e32835e01f6.
Clinicians' adherence to the Centers for Disease Control guidelines to prevent group B Streptococcus (GBS) early-onset sepsis (EOS) has reduced GBS EOS. Although evidence-based testing and empirical antibiotic initiation are likely saving lives, clinicians have less compelling data to guide duration of empirically initiated antibiotics when cultures remain sterile and clinical signs resolve quickly. Our purpose is to review current opinions and evidence influencing clinicians' choices for duration of empirically initiated antibiotics in newborns with sterile cultures.
Retrospective cohort studies indicate potential for harm with longer duration of empirical antibiotics for EOS when cultures are sterile. Cohort studies indicate timing of widely used tests used to estimate EOS risk affects their predictive value, and tests acquired 24-48 h postnatally may provide reassurance for safe discontinuation.
Every day clinicians caring for thousands of neonates in the United States stop antibiotics which were started empirically to treat EOS on the first postnatal day. Evidence is lacking to support a universal approach to decisions on duration of empirical antibiotics when cultures remain sterile. Reviewing predictive value relative to timing of laboratory testing can help clinicians develop locally appropriate antimicrobial duration decision-making guidelines.
临床医生遵循疾病控制中心的指导方针预防 B 组链球菌（GBS）早发脓毒症（EOS），从而降低了 GBS EOS 的发生率。尽管基于证据的检测和经验性抗生素的应用可能挽救了生命，但在培养结果仍为无菌且临床症状迅速缓解时，临床医生指导经验性抗生素应用时间长短的依据并不充分。我们旨在综述影响临床医生在无菌培养新生儿中经验性抗生素应用时间长短决策的现有观点和证据。
无菌培养时，EOS 经验性抗生素应用时间延长可能存在潜在危害的回顾性队列研究。队列研究表明，用于估计 EOS 风险的常用检测方法的时间会影响其预测价值，并且在出生后 24-48 小时获得的检测结果可能有助于确保安全停药。
在美国，每天都有成千上万的新生儿接受治疗，临床医生会根据经验停止使用抗生素治疗第一天的 EOS。缺乏证据支持在培养结果仍为无菌时，对经验性抗生素应用时间长短的决策采用通用方法。相对于实验室检测时间的预测价值的评估可以帮助临床医生制定适合当地的抗菌药物持续时间决策指南。
