Chu Shih-Ming, Hsu Jen-Fu, Lai Mei-Yin, Huang Hsuan-Rong, Chiang Ming-Chou, Fu Ren-Huei, Tsai Ming-Horng
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan.
Antibiotics (Basel). 2020 Apr 23;9(4):203. doi: 10.3390/antibiotics9040203.
Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU).
An 8-year (1 January 2007-31 December 2014) cohort study of all NICU patients with gram-negative bacteremia (GNB) in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient did not receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture sampling. Neonates with GNB treated with inadequate antibiotics were compared with those who received initial adequate antibiotics.
Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistance to prescribed antibiotics (88.0%). Bacteremia caused by (Odds ratio [OR]: 20.8, < 0.001) and extended spectrum β-lactamase (ESBL)-producing bacteria (OR: 18.4, < 0.001) had the highest risk of inadequate treatment. Previous exposure with third generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18-5.37, = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including a higher risk of major organ damage (20.0% versus 6.6%, < 0.001) and infectious complications (25.3% versus 9.3%, < 0.001), and overall mortality (22.7% versus 11.0%, = 0.013). : Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Additional prospective studies are needed to elucidate the optimal timing and aggressive antibiotic regimen for neonates who are at risk of antibiotic-resistant Gram-negative bacteremia.
及时恰当的经验性抗生素治疗对革兰阴性菌血症的危重症患者起着重要作用。然而，在新生儿重症监护病房（NICU）中，相关数据及显著影响尚未得到充分研究。
对一家三级医疗中心8年（2007年1月1日至2014年12月31日）期间所有NICU革兰阴性菌血症（GNB）患者进行队列研究。当患者在血培养采样后24小时内未接受任何对致病微生物敏感的抗菌药物治疗时，定义为经验性抗生素治疗不足。将接受抗生素治疗不足的GNB新生儿与接受初始适当抗生素治疗的新生儿进行比较。
在376例革兰阴性菌血症发作中，75例（19.9%）接受了不足的经验性抗生素治疗。治疗不足的原因主要是病原体对规定抗生素耐药（88.0%）。[具体细菌名称]引起的菌血症（优势比[OR]：20.8，P<0.001）和产超广谱β-内酰胺酶（ESBL）细菌引起的菌血症（OR：18.4，P<0.001）治疗不足的风险最高。既往使用第三代头孢菌素被确定为唯一的独立危险因素（OR：2.52，95%可信区间：1.18 - 5.37，P = 0.018）。经验性治疗不足的菌血症比治疗充分的菌血症更有可能出现更差的结局，包括主要器官损害风险更高（20.0%对6.6%，P<0.001）、感染并发症风险更高（25.3%对9.3%，P<0.001）以及总体死亡率更高（22.7%对11.0%，P = 0.013）。结论：NICU中五分之一的革兰阴性菌血症存在经验性抗生素治疗不足的情况，且与更差的结局相关。需要进一步的前瞻性研究来阐明有抗生素耐药革兰阴性菌血症风险的新生儿的最佳治疗时机和积极的抗生素治疗方案。
