Moreno M T, Vargas S, Poveda R, Sáez-Llorens X
Hospital del Niño, Panama.
Pediatr Infect Dis J. 1994 Jun;13(6):516-20. doi: 10.1097/00006454-199406000-00010.
In a retrospective study at Hospital del Niño in Panama City, Panama, 577 neonates with culture-proved sepsis and/or meningitis were identified during an 18-year period (1975 to 1992). Overall there was an incidence of 3.5 cases/1000 live births. Three hundred thirty-three patients (58%) were of low birth weight (< 2500 g) and 260 (45%) were premature. Gram-negative bacilli, particularly species of Klebsiella and Escherichia coli, were responsible for 61% of infections, whereas Gram-positive isolates (especially staphylococci) and Candida strains accounted for 37 and 2%, respectively. The patterns of predominance among bacterial pathogens, however, changed during the period of study. In the later years of this study the frequency of Gram-negative bacteria declined whereas those of staphylococci and Candida increased. Likewise systemic infections caused by Group B Streptococcus organisms appeared recently. The case-fatality rate was 32%. Mortality was greater in infants with early onset sepsis than in those with late infections (44% vs. 22%, P < 0.0001; odds ratio, 2.8; 95% confidence interval, 1.9 to 4.1) and lesser in neonates infected by coagulase-negative staphylococci than in those infected by any other pathogen (12 vs. 39%, P < 0.001; odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4). These findings provide guidelines for the selection of empiric antimicrobial agents in our country and possibly in other Latin American countries and suggest that a continued thorough epidemiologic evaluation is needed to anticipate bacteriologic changes over time.
在巴拿马城的巴拿马儿童医院进行的一项回顾性研究中，在18年期间（1975年至1992年）共识别出577例经培养证实患有败血症和/或脑膜炎的新生儿。总体发病率为每1000例活产中有3.5例。333例患者（58%）出生体重低（<2500克），260例（45%）为早产儿。革兰氏阴性杆菌，尤其是克雷伯菌属和大肠杆菌，导致了61%的感染，而革兰氏阳性菌（尤其是葡萄球菌）和念珠菌菌株分别占37%和2%。然而，在研究期间，细菌病原体的优势模式发生了变化。在该研究的后期，革兰氏阴性菌的频率下降，而葡萄球菌和念珠菌的频率增加。同样，由B组链球菌引起的全身感染最近也出现了。病死率为32%。早发型败血症婴儿的死亡率高于晚发型感染婴儿（44%对22%，P<0.0001；优势比，2.8；95%置信区间，1.9至4.1），而凝固酶阴性葡萄球菌感染的新生儿死亡率低于其他任何病原体感染的新生儿（12%对39%，P<0.001；优势比，0.2；95%置信区间，0.1至0.4）。这些发现为我国以及其他拉丁美洲国家选择经验性抗菌药物提供了指导方针，并表明需要持续进行全面的流行病学评估，以预测细菌学随时间的变化。
