婴儿重症监护病房住院婴儿中的革兰氏阴性杆菌。
Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit.
机构信息
Department of Pediatrics, Columbia University Medical Center, New York, New York.
Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, Delaware.
出版信息
J Pediatric Infect Dis Soc. 2017 Sep 1;6(3):227-230. doi: 10.1093/jpids/piw032.
BACKGROUND
Gram-negative bacilli (GNB) account for a significant burden of infection and colonization in neonatal intensive care units (NICUs), and antibiotic resistance among these pathogens is of increasing concern.
METHODS
A prospective cohort study was performed in 4 NICUs between May 2009 and April 2012. The body sites from which GNB were isolated, antimicrobial susceptibilities of the GNB isolated, and antimicrobial therapy were assessed.
RESULTS
Attending neonatologists treated 3.0% (188 of 6184) of eligible infants for GNB infection; 23% of 214 GNB isolates were nonsusceptible to antimicrobial agents, including gentamicin (14.8%), piperacillin-tazobactam (9.9%), third-generation cephalosporin (7.0%), and/or carbapenem agents (4.5%). Gentamicin was the most commonly used antibiotic overall, and much of its use was empiric. However, third-generation cephalosporin agents and cefepime were used more commonly as targeted therapy for identified Gram-negative pathogens.
CONCLUSIONS
One-quarter of the GNB isolates were nonsusceptible to ≥1 antibiotic. Antimicrobial stewardship strategies for reducing antimicrobial use in NICUs should be implemented.
背景
革兰氏阴性杆菌（GNB）在新生儿重症监护病房（NICU）中造成了严重的感染和定植负担，这些病原体的抗生素耐药性日益受到关注。
方法
2009 年 5 月至 2012 年 4 月，在 4 家 NICU 进行了一项前瞻性队列研究。评估了从 GNB 分离的部位、GNB 分离株的抗菌药敏性和抗菌治疗。
结果
主治新生儿科医生治疗了 3.0%（6184 名合格婴儿中的 188 名）患有 GNB 感染的婴儿；214 株 GNB 分离株中，有 23%对包括庆大霉素（14.8%）、哌拉西林-他唑巴坦（9.9%）、第三代头孢菌素（7.0%）和/或碳青霉烯类药物（4.5%）在内的抗菌药物不敏感。总的来说，庆大霉素是最常用的抗生素，而且其使用大部分是经验性的。然而，第三代头孢菌素类药物和头孢吡肟更常用于针对确定的革兰氏阴性病原体的靶向治疗。
结论
四分之一的 GNB 分离株对≥1 种抗生素不敏感。应实施减少 NICU 中抗生素使用的抗菌药物管理策略。
Zotero 插件