足月儿和晚期早产儿早发型败血症风险当前管理的差异：一项国际调查及指南综述

Variation in Current Management of Term and Late-preterm Neonates at Risk for Early-onset Sepsis: An International Survey and Review of Guidelines.

作者信息

van Herk Wendy, el Helou Salhab, Janota Jan, Hagmann Cornelia, Klingenberg Claus, Staub Eveline, Giannoni Eric, Tissieres Pierre, Schlapbach Luregn J, van Rossum Annemarie M C, Pilgrim Sina B, Stocker Martin

机构信息

From the *Division of Infectious Diseases and Immunology, Department of Pediatrics, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; †Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada; ‡Department of Neonatology, Thomayer Hospital, Prague, Czech Republic; §Institute of Pathological Physiology, First Medical Faculty, Charles University in Prague, Czech Republic; ¶University Hospital Zurich, Zurich, Switzerland; ‖Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway; **Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway; ††Department of Neonatology, The Children's Hospital at Westmead, New South Wales, Australia; ‡‡Service of Neonatology, University Hospital of Lausanne, Lausanne, Switzerland; §§Department of Pediatrics, Hôpitaux Universitaires Paris-Sud AP-HP, Le Kremlin-Bicêtre, France; ¶¶Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia; ‖‖Department of Pediatrics, Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia; ***Department of Pediatrics, University Children's Hospital Berne, Berne, Switzerland; and †††Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.

出版信息

Pediatr Infect Dis J. 2016 May;35(5):494-500. doi: 10.1097/INF.0000000000001063.

DOI:10.1097/INF.0000000000001063

PMID:26766143

Abstract

BACKGROUND

Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management.

METHODS

A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n = 5) were reviewed and compared with the results of the survey.

RESULTS

439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for 5-7 days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations.

CONCLUSIONS

There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

摘要

背景

对于存在感染的不确定性导致对有早发性败血症（EOS）风险的新生儿进行不必要且延长的经验性抗生素治疗。本研究评估这种不确定性对管理多样性的影响。

方法

在欧洲、北美和澳大利亚进行了一项基于网络的调查，其中包含针对感染风险调整后情景管理的问题。对已发表的国家指南（n = 5）进行了审查并与调查结果进行比较。

结果

来自16个国家的439名临床医生（68%为新生儿科医生）完成了调查。在低风险情景中，29%会开始抗生素治疗，26%不会，两组均未进行实验室检查；如果实验室指标异常，45%会开始治疗。在高风险情景中，99%会开始抗生素治疗。在低风险情景中，89%会在72小时前停止抗生素治疗。在高风险情景中，35%会在72小时前停止治疗，56%会持续治疗5 - 7天，9%会持续治疗超过7天。31%的情景中使用实验室检查来决定是否开始治疗，72%的情景中用于决定是否停止抗生素治疗。国家指南在低风险情况下关于开始治疗的决定以及高风险情况下关于继续治疗的决定存在很大差异。