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少即是多：生命早期使用抗生素。

Less is more: Antibiotics at the beginning of life.

机构信息

Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.

Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.

出版信息

Nat Commun. 2023 Apr 27;14(1):2423. doi: 10.1038/s41467-023-38156-7.

DOI:10.1038/s41467-023-38156-7
PMID:37105958
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10134707/
Abstract

Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.

摘要

生命早期接触抗生素会导致抗菌药物耐药性增加和发育中微生物组的紊乱。生命早期微生物组破坏会增加日后患慢性疾病的风险。担心错过新生儿脓毒症的演变是生命早期抗生素过度治疗的关键驱动因素。偏见（系统偏向过度治疗）和噪声（随机分散）会影响决策过程。在这种观点下，我们提倡采取一种实际的方法，根据疾病负担来量化治疗负担，平衡抗菌药物管理和有效的脓毒症管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/4b8c75778c18/41467_2023_38156_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/7adaa0dd6c73/41467_2023_38156_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/c6deae767018/41467_2023_38156_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/4b8c75778c18/41467_2023_38156_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/7adaa0dd6c73/41467_2023_38156_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/c6deae767018/41467_2023_38156_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be17/10140041/4b8c75778c18/41467_2023_38156_Fig3_HTML.jpg

相似文献

[1]
Less is more: Antibiotics at the beginning of life.

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[2]
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[3]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Artificial intelligence should genuinely support clinical reasoning and decision making to bridge the translational gap.

NPJ Digit Med. 2025-6-10

[2]
Neonatal leucocyte cell population data: reference intervals and relevance for detecting sepsis and necrotizing enterocolitis.

Pediatr Res. 2025-6-6

[3]
Perinatal Antibiotic Exposure and Respiratory Outcomes in Children Born Preterm.

JAMA Netw Open. 2025-5-1

[4]
Survival of the Littlest: Navigating Sepsis Diagnosis beyond Inflammation in Preterm Neonates.

J Proteome Res. 2025-6-6

[5]
Antimicrobial Therapies for Early-Onset Group B Streptococcal Sepsis: Insights from an Italian Multicenter Study.

Antibiotics (Basel). 2025-4-16

[6]
Absence of association between early antibiotic exposure and short-term adverse outcomes in very preterm infants: a single-center retrospective study.

Front Pediatr. 2025-3-17

[7]
Microbial Infections and Antimicrobial Use in Neonates and Infants.

Trop Med Infect Dis. 2025-3-18

[8]
Metagenomic signatures of extraintestinal bacterial infection in the febrile term infant gut microbiome.

Microbiome. 2025-3-24

[9]
Sepsis: the evolution of molecular pathogenesis concepts and clinical management.

MedComm (2020). 2025-2-23

[10]
Negative Healthcare Impacts of Management of Presumed Early-Onset Sepsis in Moderate to Late Preterm Infants on Feeding, Jaundice, and Hospital Length of Stay.

Healthcare (Basel). 2025-1-13

本文引用的文献

[1]
Kotter's 8 stages of change: implementation of clinical screening protocols for assessing patients for COVID-19 - a review of an academic medical centre's preparedness.

BMJ Lead. 2022-12

[2]
Late-onset sepsis in very preterm infants in Norway in 2009-2018: a population-based study.

Arch Dis Child Fetal Neonatal Ed. 2023-9

[3]
The next generation of evidence-based medicine.

Nat Med. 2023-1

[4]
Gut microbiome-wide association study of depressive symptoms.

Nat Commun. 2022-12-6

[5]
Analysis of Antibiotic Exposure and Early-Onset Neonatal Sepsis in Europe, North America, and Australia.

JAMA Netw Open. 2022-11-1

[6]
Microbiome epidemiology and association studies in human health.

Nat Rev Genet. 2023-2

[7]
Early Empirical Antibiotics and Adverse Clinical Outcomes in Infants Born Very Preterm: A Population-Based Cohort.

J Pediatr. 2023-2

[8]
Data capture and sharing in the COVID-19 pandemic: a cause for concern.

Lancet Digit Health. 2022-10

[9]
The Johns Hopkins University Center for Systems Science and Engineering COVID-19 Dashboard: data collection process, challenges faced, and lessons learned.

Lancet Infect Dis. 2022-12

[10]
Association between duration of early empiric antibiotics and necrotizing enterocolitis and late-onset sepsis in preterm infants: a multicenter cohort study.

Eur J Pediatr. 2022-10

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