晚期早产儿和足月儿血培养阴性早发型败血症的抗生素暴露：一项国际研究。
Antibiotic exposure for culture-negative early-onset sepsis in late-preterm and term newborns: an international study.
作者信息
Dimopoulou Varvara, Klingenberg Claus, Navér Lars, Nordberg Viveka, Berardi Alberto, El Helou Salhab, Fusch Gerhard, Bliss Joseph M, Lehnick Dirk, Guerina Nicholas, Seliga-Siwecka Joanna, Maton Pierre, Lagae Donatienne, Mari Judit, Janota Jan, Agyeman Philipp K A, Pfister Riccardo, Latorre Giuseppe, Maffei Gianfranco, Laforgia Nicola, Mózes Enikő, Størdal Ketil, Strunk Tobias, Stocker Martin, Giannoni Eric
机构信息
Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Research Group for Child and Adolescent Health, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
出版信息
Pediatr Res. 2025 Apr;97(5):1629-1635. doi: 10.1038/s41390-024-03532-6. Epub 2024 Sep 17.
BACKGROUND
Early-life antibiotic exposure is disproportionately high compared to the burden of culture-proven early-onset sepsis (CP-EOS). We assessed the contribution of culture-negative cases to the overall antibiotic exposure in the first postnatal week.
METHODS
We conducted a retrospective analysis across eleven countries in Europe, North America, and Australia. All late-preterm and term infants born between 2014 and 2018 who received intravenous antibiotics during the first postnatal week were classified as culture-negative cases treated for ≥5 days (CN ≥ 5d), culture-negative cases treated for <5 days (CN < 5d), or CP-EOS cases.
RESULTS
Out of 757,979 infants, 21,703 (2.9%) received intravenous antibiotics. The number of infants classified as CN ≥ 5d, CN < 5d, and CP-EOS was 7996 (37%), 13,330 (61%), and 375 (1.7%). The incidence of CN ≥ 5d, CN < 5d, and CP-EOS was 10.6 (95% CI 10.3-10.8), 17.6 (95% CI 17.3-17.9), and 0.49 (95% CI 0.44-0.54) cases per 1000 livebirths. The median (IQR) number of antibiotic days administered for CN ≥ 5d, CN < 5d, and CP-EOS was 77 (77-78), 53 (52-53), and 5 (5-5) per 1000 livebirths.
CONCLUSIONS
CN ≥ 5d substantially contributed to the overall antibiotic exposure, and was 21-fold more frequent than CP-EOS. Antimicrobial stewardship programs should focus on shortening antibiotic treatment for culture-negative cases.
IMPACT
In a study of 757,979 infants born in high-income countries, we report a presumed culture-negative early-onset sepsis incidence of 10.6/1000 livebirths with an associated antibiotic exposure of 77 antibiotic days per 1000 livebirths. This study sheds light on the major contribution of presumed culture-negative early-onset sepsis to early-life antibiotic exposure. Given the diagnostic uncertainty surrounding culture-negative early-onset sepsis, the low mortality rate, and the disproportionate antibiotic exposure associated with this condition, our study emphasizes the importance of targeting culture-negative early-onset sepsis in antimicrobial stewardship programs.
背景
与经培养证实的早发性败血症（CP-EOS）负担相比，生命早期抗生素暴露比例过高。我们评估了培养阴性病例对出生后第一周总体抗生素暴露的影响。
方法
我们对欧洲、北美和澳大利亚的11个国家进行了回顾性分析。所有在2014年至2018年之间出生的晚期早产儿和足月儿，若在出生后第一周接受了静脉抗生素治疗，则被分类为接受≥5天治疗的培养阴性病例（CN≥5d）、接受<5天治疗的培养阴性病例（CN<5d）或CP-EOS病例。
结果
在757,979名婴儿中，21,703名（2.9%）接受了静脉抗生素治疗。被分类为CN≥5d、CN<5d和CP-EOS的婴儿数量分别为7996名（37%）、13,330名（61%）和375名（1.7%）。CN≥5d、CN<5d和CP-EOS的发病率分别为每1000例活产10.6例（95%置信区间10.3 - 10.8）、17.6例（95%置信区间17.3 - 17.9）和0.49例（95%置信区间0.44 - 0.54）。每1000例活产中，CN≥5d、CN<5d和CP-EOS的抗生素使用天数中位数（四分位间距）分别为77天（77 - 78天）、53天（52 - 53天）和5天（5 - 5天）。
结论
CN≥5d对总体抗生素暴露有显著影响，其发生率比CP-EOS高21倍。抗菌药物管理计划应侧重于缩短培养阴性病例的抗生素治疗时间。
影响
在一项对高收入国家出生的757,979名婴儿的研究中，我们报告推测的培养阴性早发性败血症发病率为每1000例活产10.6例，每1000例活产相关的抗生素暴露天数为77天。本研究揭示了推测的培养阴性早发性败血症对生命早期抗生素暴露的主要影响。鉴于围绕培养阴性早发性败血症的诊断不确定性、低死亡率以及与此病症相关的不成比例的抗生素暴露，我们的研究强调了在抗菌药物管理计划中针对培养阴性早发性败血症的重要性。
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