Ou-Yang Mei-Chen, Hsu Jen-Fu, Chu Shih-Ming, Chang Ching-Min, Chen Chih-Chen, Huang Hsuan-Rong, Yang Peng-Hong, Fu Ren-Huei, Tsai Ming-Horng
School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Antibiotics (Basel). 2023 Feb 23;12(3):445. doi: 10.3390/antibiotics12030445.
Empiric antibiotics are often prescribed in critically ill and preterm neonates at birth until sepsis can be ruled out. Although the current guideline suggests narrow-spectrum antibiotics, an upgrade in antibiotics is common in the neonatal intensive care unit. The impacts of initial broad-spectrum antibiotics on the outcomes of critically ill neonates with respiratory failure requiring mechanical intubation have not been well studied. A total of 1162 neonates from a tertiary level neonatal intensive care unit (NICU) in Taiwan who were on mechanical ventilation for respiratory distress/failure at birth were enrolled, and neonates receiving ampicillin plus cefotaxime were compared with those receiving ampicillin plus gentamicin. Propensity score-matched analysis was used to investigate the effects of ampicillin plus cefotaxime on the outcomes of critically ill neonates. Ampicillin plus cefotaxime was more frequently prescribed for intubated neonates with lower birth weight, higher severity of illness, and those with a high risk of early-onset sepsis. Only 11.1% of these neonates had blood culture-confirmed early-onset sepsis and/or congenital pneumonia. The use of ampicillin plus cefotaxime did not significantly contribute to improved outcomes among neonates with early-onset sepsis. After propensity score-matched analyses, the critically ill neonates receiving ampicillin plus cefotaxime had significantly worse outcomes than those receiving ampicillin plus gentamicin, including a higher risk of late-onset sepsis caused by multidrug-resistant pathogens (11.2% versus 7.1%, = 0.027), longer duration of hospitalization (median [IQR], 86.5 [47-118.8] days versus 78 [45.0-106.0] days, = 0.002), and a significantly higher risk of in-hospital mortality (14.2% versus 9.6%, = 0.023). Ampicillin plus cefotaxime should not be routinely prescribed as the empiric antibiotics for critically ill neonates at birth because they were associated with a higher risk of infections caused by multidrug-resistant pathogens and final worse outcomes.
在危重症和早产新生儿出生时通常会经验性使用抗生素，直至排除败血症。尽管当前指南建议使用窄谱抗生素，但在新生儿重症监护病房升级抗生素的情况很常见。初始广谱抗生素对需要机械通气的呼吸衰竭危重症新生儿结局的影响尚未得到充分研究。我们纳入了台湾一家三级新生儿重症监护病房（NICU）中1162例出生时因呼吸窘迫/衰竭接受机械通气的新生儿，将接受氨苄西林加头孢噻肟的新生儿与接受氨苄西林加庆大霉素的新生儿进行比较。采用倾向评分匹配分析来研究氨苄西林加头孢噻肟对危重症新生儿结局的影响。出生体重较低、疾病严重程度较高且有早发型败血症高风险的插管新生儿更常使用氨苄西林加头孢噻肟。这些新生儿中只有11.1%血培养确诊为早发型败血症和/或先天性肺炎。使用氨苄西林加头孢噻肟对早发型败血症新生儿的结局改善没有显著作用。经过倾向评分匹配分析后，接受氨苄西林加头孢噻肟的危重症新生儿结局明显比接受氨苄西林加庆大霉素的新生儿差，包括由多重耐药病原体引起的晚发型败血症风险更高（11.2%对7.1%，P = 0.027）、住院时间更长（中位数[四分位间距]，86.5[47 - 118.8]天对78[45.0 - 106.0]天，P = 0.002）以及院内死亡风险显著更高（14.2%对9.6%，P = 0.023）。出生时不应常规将氨苄西林加头孢噻肟作为危重症新生儿的经验性抗生素，因为它们与多重耐药病原体引起感染的风险更高以及最终结局更差有关。
