Department of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT.
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Pediatr. 2018 Sep;200:210-217.e1. doi: 10.1016/j.jpeds.2018.04.033. Epub 2018 May 18.
To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities.
Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data.
Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone.
For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.
通过描述病原体及其药敏情况，为 60 天内疑似侵袭性细菌感染的婴儿提供经验性治疗指导。
这是一项横断面研究，纳入了 2011 年 7 月 1 日至 2016 年 6 月 30 日期间 11 家儿童医院急诊科收治的≤60 天侵袭性细菌感染（菌血症和/或细菌性脑膜炎）婴儿。每个医院的微生物实验室数据库或电子病历系统均进行了检索，以确定从血液或脑脊液中分离出细菌病原体的婴儿。回顾这些婴儿的病历以确认病原体的存在，并获取人口统计学、临床和实验室数据。
442 例侵袭性细菌感染婴儿中，353 例（79.9%）为菌血症而无脑膜炎，64 例（14.5%）为菌血症合并细菌性脑膜炎，25 例（5.7%）为细菌性脑膜炎而无脑膜炎。侵袭性细菌感染的发病高峰在出生后第 2 周；364 例（82.4%）婴儿发热。最常见的病原体为 B 群链球菌（36.7%），其次为大肠埃希菌（30.8%）、金黄色葡萄球菌（9.7%）和肠球菌属（6.6%）。总体而言，96.8%的病原体对氨苄西林+第三代头孢菌素敏感，96.0%对氨苄西林+庆大霉素敏感，89.2%对第三代头孢菌素单独敏感。
对于大多数在儿科急诊科就诊的疑似侵袭性细菌感染的≤60 天婴儿，氨苄西林+庆大霉素或第三代头孢菌素的联合用药是一种合适的经验性抗菌治疗方案。从侵袭性细菌感染婴儿分离的病原体中，有 11%单独对第三代头孢菌素耐药。
