Folgori Laura, Bielicki Julia
Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom.
Department of Paediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland.
J Pediatr Intensive Care. 2019 Mar;8(1):17-24. doi: 10.1055/s-0038-1677535. Epub 2019 Jan 17.
The incidence of severe infections caused by multidrug-resistant (MDR) pathogens is currently rising worldwide, and increasing numbers of neonates and children with serious bloodstream infections due to resistant bacteria are being reported. Severe sepsis and septic shock due to gram-negative bacteria represent a significant cause of morbidity and mortality, and contribute to high health care costs. Antimicrobial resistance among Enterobacteriaceae represents a major problem in both health care-associated and community-acquired infections, with extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE) now presenting the main threat. These infections in adult populations have been associated with poor clinical outcomes, but very limited data have been published so far about risk factors and clinical outcome of ESBL-associated and CRE sepsis in the pediatric population. The treatment of these infections in neonates and children is particularly challenging due to the limited number of available effective antimicrobials. Evidence-based use of new and older antibiotics based on both strategic and regulatory clinical trials is paramount to improve management of these severe infections in neonates and children.
目前，全球范围内由多重耐药（MDR）病原体引起的严重感染发病率正在上升，据报道，因耐药菌导致严重血流感染的新生儿和儿童数量也在增加。革兰氏阴性菌引起的严重脓毒症和脓毒性休克是发病和死亡的重要原因，也导致了高昂的医疗费用。肠杆菌科细菌的耐药性是医疗保健相关感染和社区获得性感染中的一个主要问题，目前，超广谱β-内酰胺酶（ESBLs）和耐碳青霉烯类肠杆菌科细菌（CRE）构成了主要威胁。这些感染在成人中与不良临床结局相关，但迄今为止，关于儿科人群中ESBL相关和CRE脓毒症的危险因素及临床结局的数据非常有限。由于可用的有效抗菌药物数量有限，新生儿和儿童这些感染的治疗尤其具有挑战性。基于战略和监管临床试验，循证使用新旧抗生素对于改善新生儿和儿童这些严重感染的管理至关重要。
