极低出生体重儿早期抗生素暴露与生后 3-7 天感染风险
Early antibiotic exposure in very-low birth weight infants and infection risk at 3-7 days after birth.
机构信息
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
J Perinatol. 2023 Sep;43(9):1158-1165. doi: 10.1038/s41372-023-01737-x. Epub 2023 Jul 25.
OBJECTIVE
To determine rates of late-onset infection (LOI) during postnatal days 3-7 among preterm infants, based on antibiotic exposure during days 0-2.
STUDY DESIGN
Retrospective cohort study of infants born <1500 grams and ≤30 weeks gestation, 2005-2018. We analyzed the incidence and microbiology of LOI at days 3-7 based on antibiotic exposure during postnatal days 0-2.
RESULTS
The cohort included 88,574 infants, of whom 85% were antibiotic-exposed. Fewer antibiotic-exposed compared to unexposed infants developed LOI (1.5% vs. 2.1%; adjusted hazard ratio, 0.28, 95% CI 0.24-0.33). Among antibiotic-exposed compared to unexposed infants, Gram-negative (38% vs. 28%, p = 0.002) and fungal (11% vs. 1%, p < 0.001) species were more commonly isolated, and gram-positive organisms (49% vs. 70%, p < 0.001) were less commonly isolated.
CONCLUSIONS
We observed low overall rates of LOI at days 3-7 after birth, but antibiotic exposure from birth was associated with lower rates, and with differing microbiology, compared to no exposure.
目的
根据出生后第 0-2 天的抗生素使用情况，确定早产儿出生后第 3-7 天的迟发性感染（LOI）发生率。
研究设计
对 2005 年至 2018 年间出生体重<1500 克且胎龄≤30 周的婴儿进行回顾性队列研究。我们根据出生后第 0-2 天的抗生素使用情况，分析第 3-7 天 LOI 的发生率和微生物学情况。
结果
该队列包括 88574 名婴儿，其中 85%接受了抗生素治疗。与未接受抗生素治疗的婴儿相比，接受抗生素治疗的婴儿发生 LOI 的比例较低（1.5%比 2.1%；调整后的危险比为 0.28，95%CI 0.24-0.33）。与未接受抗生素治疗的婴儿相比，接受抗生素治疗的婴儿中革兰氏阴性（38%比 28%，p=0.002）和真菌（11%比 1%，p<0.001）的分离率更高，而革兰氏阳性菌（49%比 70%，p<0.001）的分离率更低。
结论
我们观察到出生后第 3-7 天 LOI 的总体发生率较低，但与无暴露相比，出生时的抗生素暴露与较低的发生率和不同的微生物学特征相关。
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