Folgori Laura, Bielicki Julia, Heath Paul T, Sharland Mike
aPaediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK bPaediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland.
Curr Opin Infect Dis. 2017 Jun;30(3):281-288. doi: 10.1097/QCO.0000000000000371.
This review summarizes the main challenges of antimicrobial resistance (AMR) in the neonatal population with a special focus on multidrug-resistant (MDR) Gram-negative pathogens.
MDR-Gram-negative bacteria are a great concern in the neonatal population, with a worldwide rise in the reported incidence and with very limited therapeutic options. Extended-spectrum β-lactamase and carbapenem-resistant Enterobacteriaceae (CRE) have been reported as responsible for neonatal ICU outbreaks. Hospital data from low/middle-income countries show high proportions of isolates from neonates resistant to the WHO first-line and second-line recommended treatments. The spread of CRE has resulted in old antibiotics, such as colistin and fosfomycin, to be considered as alternative treatment options, despite the paucity of available data on safety and appropriate dosage.
Improved global neonatal AMR surveillance programmes including both epidemiology and clinical outcomes are critical for defining the burden and designing interventions. The optimal empiric treatment for neonatal sepsis in settings of high rates of AMR is currently unknown. Both strategic trials of older antibiotics and regulatory trials of new antibiotics are required to improve clinical outcomes in MDR-Gram-negative neonatal sepsis.
本综述总结了新生儿群体中抗菌药物耐药性（AMR）的主要挑战，特别关注多重耐药（MDR）革兰氏阴性病原体。
多重耐药革兰氏阴性菌是新生儿群体中的一大担忧，全球报告的发病率呈上升趋势，且治疗选择非常有限。超广谱β-内酰胺酶和耐碳青霉烯类肠杆菌科细菌（CRE）已被报道是新生儿重症监护病房暴发的原因。来自低收入/中等收入国家的医院数据显示，新生儿分离株对世界卫生组织一线和二线推荐治疗耐药的比例很高。CRE的传播导致黏菌素和磷霉素等老抗生素被视为替代治疗选择，尽管关于安全性和适当剂量的可用数据很少。
改进包括流行病学和临床结果的全球新生儿AMR监测计划对于确定负担和设计干预措施至关重要。目前尚不清楚在AMR发生率高的情况下新生儿败血症的最佳经验性治疗方法。需要进行老抗生素的战略试验和新抗生素的监管试验，以改善多重耐药革兰氏阴性新生儿败血症的临床结果。
