Mukhopadhyay Sagori, Puopolo Karen M
From the *Division of Neonatology, Children's Hospital of Philadelphia, and †Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Pediatr Infect Dis J. 2017 May;36(5):477-481. doi: 10.1097/INF.0000000000001473.
Most very low birth weight (VLBW, birth weight <1500 g) infants receive empiric antibiotics for risk of early-onset sepsis (EOS). The objective of this study was to determine the characteristics of VLBW infants with culture-confirmed EOS at a single center during 25 years and to identify opportunities for antibiotic stewardship.
Retrospective cohort study includes VLBW infants admitted from 1990 to 2015. EOS was defined as isolation of a pathogen in blood or cerebrospinal fluid culture obtained at <72 hours of age. Clinical and microbiologic characteristics of EOS case infants were obtained by review of medical, laboratory and administrative records. Blood culture, antibiotic initiation and maternal discharge code data were available for all VLBW infants born between 1999 and 2013.
One-hundred nine EOS cases (20.5/1000 VLBW births) occurred during the study period. Preterm labor, preterm rupture of membranes and/or the obstetrical diagnosis of chorioamnionitis were present in 106/109 cases (97%). Obligate anaerobic organisms accounted for 16% of cases. Time to culture positivity was 36 hours for 88% and 48 hours for 98% of cases. From 1999 to 2013, 97% of VLBW infants were evaluated for EOS and 90% administered empiric antibiotics; 22% of these infants were born by cesarean section to mothers with preeclampsia and without preterm labor or chorioamnionitis and had a 12-fold lower incidence of EOS compared with the remaining infants.
Decisions to initiate and discontinue empiric antibiotics among VLBW infants can be informed by the delivery characteristics of infected infants and by local microbiologic data.
大多数极低出生体重（VLBW，出生体重<1500克）婴儿因有早发型败血症（EOS）风险而接受经验性抗生素治疗。本研究的目的是确定25年间在单一中心培养确诊的EOS极低出生体重婴儿的特征，并确定抗生素管理的机会。
回顾性队列研究纳入了1990年至2015年入院的极低出生体重婴儿。EOS定义为在出生后<72小时获得的血液或脑脊液培养中分离出病原体。通过查阅医疗、实验室和行政记录获得EOS病例婴儿的临床和微生物学特征。1999年至2013年间出生的所有极低出生体重婴儿均有血培养、抗生素起始和母亲出院代码数据。
研究期间共发生109例EOS病例（每1000例极低出生体重儿中有20.5例）。106/109例（97%）存在早产、胎膜早破和/或产科诊断的绒毛膜羊膜炎。专性厌氧菌占病例的16%。88%的病例培养阳性时间为36小时，98%的病例为48小时。1999年至2013年，97%的极低出生体重婴儿接受了EOS评估，90%接受了经验性抗生素治疗；这些婴儿中有22%是通过剖宫产出生的，母亲患有先兆子痫，没有早产或绒毛膜羊膜炎，与其余婴儿相比，EOS发病率低12倍。
极低出生体重婴儿经验性抗生素的起始和停用决策可根据感染婴儿的分娩特征和当地微生物学数据做出。
