波兰克拉科夫两家新生儿重症监护病房 2016-2017 年新生儿败血症的流行病学研究。

Epidemiology of neonatal sepsis in two neonatal intensive care units in Krakow, Poland in 2016-2017 years.

机构信息

Chair of Microbiology, Jagiellonian University Medical College, Czysta 18 Street, Cracow, 31-121, Poland.

Department of Microbiology, University Hospital, Cracow, Poland.

出版信息

BMC Infect Dis. 2023 Nov 24;23(1):827. doi: 10.1186/s12879-023-08836-2.

DOI:10.1186/s12879-023-08836-2

PMID:38001444

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10675960/

Abstract

BACKGROUND

Sepsis in low-birth-weight neonates remains one of the most significant causes of neonatal morbidity and mortality. Approximately 3 million newborns suffer from sepsis globally every year. The aim of this study was to compare demographic and clinical features, as well as etiology and antibiotic susceptibility, of the main pathogens related to neonatal sepsis in two neonatal intensive units during a two-year period.

METHODS

We observed early-onset (EO-BSI) and late-onset bloodstream infections (LO-BSI) cases in two high-reference neonatal intensive care units (NICU) over a 24-month period (2016-2017). Samples of patients' blood were tested for the presence of the microorganisms. All bacterial isolates were tested for susceptibility to antibiotics.

RESULTS

The majority of sepsis cases weighed above 1000 g and were born by cesarean section. About 10% of the EO-BSI group died. There were differences in the EO-BSI /LO-BSI ratio in the compared wards due to differences among the admitted children. The most common pathogens isolated from blood were coagulase-negative staphylococci (CoNS) were represented by two dominating species: S. epidermidis and S. haemolyticus, followed by Klebsiella spp. strains and E.coli, which were mostly found in EO-BSI cases. No single S. agalactiae (GBS) strain was isolated. The majority of CoNS strains were resistant to methicillin, half were resistant to aminoglycosides, and one-third were resistant to macrolides and lincosamides. Half of the Gram-negative rods were resistant to beta-lactams.

CONCLUSIONS

The epidemiology of sepsis in two observed NICUs is comparable to data obtained from other studies with a predominance of methicillin-resistant CoNS in LO-BSI and beta-lactam resistant E. coli in EO-BSI. It is of importance that the campaign for controlling GBS carriage in pregnant women in Poland resulted in the disappearance of GBS as a cause of sepsis. Unfortunately, there are no such measures to control E.coli related sepsis.

摘要

背景

低体重儿败血症仍然是新生儿发病率和死亡率的主要原因之一。每年，全球约有 300 万新生儿患有败血症。本研究的目的是比较两年内在两个新生儿重症监护病房（NICU）中与新生儿败血症有关的主要病原体的人口统计学和临床特征、病因和抗生素敏感性。

方法

我们观察了两个高参考 NICU 中 24 个月（2016-2017 年）的早发性（EO-BSI）和晚发性血流感染（LO-BSI）病例。对患者血液样本进行了微生物检测。所有分离的细菌均进行了抗生素敏感性检测。

结果

大多数败血症病例体重超过 1000 克，且为剖宫产分娩。EO-BSI 组约有 10%的患儿死亡。由于收治的患儿不同，两个病房的 EO-BSI/LO-BSI 比例存在差异。从血液中分离的最常见病原体是凝固酶阴性葡萄球菌（CoNS），以两种主要种属为主：表皮葡萄球菌和溶血葡萄球菌，其次是克雷伯菌属和大肠杆菌，这些主要见于 EO-BSI 病例中。未分离到单一的无乳链球菌（GBS）菌株。大多数 CoNS 菌株对甲氧西林耐药，半数对氨基糖苷类耐药，三分之一对大环内酯类和林可酰胺类耐药。半数革兰氏阴性杆菌对β-内酰胺类耐药。

结论

两个观察 NICU 中败血症的流行病学与其他研究的数据相似，表现为 LO-BSI 中以耐甲氧西林 CoNS 为主，EO-BSI 中以耐β-内酰胺类的大肠杆菌为主。波兰控制孕妇携带 GBS 的运动导致 GBS 作为败血症的病因消失，这一点很重要。不幸的是，没有针对控制与大肠杆菌相关的败血症的此类措施。