Boscarino Giovanni, Romano Rossana, Iotti Carlotta, Tegoni Francesca, Perrone Serafina, Esposito Susanna
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
PNeonatology Unit, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Antibiotics (Basel). 2024 Mar 10;13(3):250. doi: 10.3390/antibiotics13030250.
Neonatal sepsis is a clinical syndrome mainly associated with a bacterial infection leading to severe clinical manifestations that could be associated with fatal sequalae. According to the time of onset, neonatal sepsis is categorized as early- (EOS) or late-onset sepsis (LOS). Despite blood culture being the gold standard for diagnosis, it has several limitations, and early diagnosis is not immediate. Consequently, most infants who start empirical antimicrobial therapy do not have an underlying infection. Despite stewardship programs partially reduced this negative trend, in neonatology, antibiotic overuse still persists, and it is associated with several relevant problems, the first of which is the increase in antimicrobial resistance (AMR). Starting with these considerations, we performed a narrative review to summarize the main findings and the future prospects regarding antibiotics use to treat neonatal sepsis. Because of the impact on morbidity and mortality that EOS and LOS entail, it is essential to start an effective and prompt treatment as soon as possible. The use of targeted antibiotics is peremptory as soon as the pathogen in the culture is detected. Although prompt therapy is essential, it should be better assessed whether, when and how to treat neonates with antibiotics, even those at higher risk. Considering that we are certainly in the worrying era defined as the "post-antibiotic era", it is still essential and urgent to define novel strategies for the development of antibacterial compounds with new targets or mechanisms of action. A future strategy could also be to perform well-designed studies to develop innovative algorithms for improving the etiological diagnosis of infection, allowing for more personalized use of the antibiotics to treat EOS and LOS.
新生儿败血症是一种主要与细菌感染相关的临床综合征，可导致严重的临床表现，并可能伴有致命的后遗症。根据发病时间，新生儿败血症可分为早发型败血症（EOS）或晚发型败血症（LOS）。尽管血培养是诊断的金标准，但它有几个局限性，且早期诊断并非立竿见影。因此，大多数开始经验性抗菌治疗的婴儿并没有潜在感染。尽管管理计划部分减少了这种负面趋势，但在新生儿科，抗生素的过度使用仍然存在，并且与几个相关问题有关，其中首要问题是抗菌药物耐药性（AMR）的增加。基于这些考虑，我们进行了一项叙述性综述，以总结关于使用抗生素治疗新生儿败血症的主要研究结果和未来前景。由于早发型败血症和晚发型败血症会对发病率和死亡率产生影响，因此尽快开始有效且及时的治疗至关重要。一旦在培养物中检测到病原体，使用针对性抗生素就势在必行。尽管及时治疗至关重要，但对于是否、何时以及如何用抗生素治疗新生儿，甚至是高危新生儿，仍应进行更好的评估。鉴于我们无疑处于被定义为“后抗生素时代”的令人担忧的时代，确定具有新靶点或作用机制的抗菌化合物开发的新策略仍然至关重要且紧迫。未来的策略还可以是开展精心设计的研究，以开发创新算法来改善感染的病因诊断，从而更个性化地使用抗生素来治疗早发型败血症和晚发型败血症。
