Pillay T, Pillay D G, Adhikari M, Sturm A W
Department of Paediatrics, University of Natal, South Africa.
Am J Perinatol. 1998 Jan;15(1):47-51. doi: 10.1055/s-2007-993898.
Nosocomial Klebsiella pneumoniae infection is associated with a high mortality in neonates and antimicrobial therapy of these infections has been complicated by the emergence of multiresistant strains. These organisms remain susceptible to only a few antimicrobial agents, and some of these are not recommended for use in children. In this study the antimicrobial agents used in the treatment of 33 neonates with Klebsiella pneumoniae (K. pneumonia) infection in our tertiary neonatal unit, during an outbreak were: piperacillin/tazobactam (13), imipenem/cilastatin (17), cefotaxime (2), and ciprofloxacin (1). Extended-spectrum beta-lactamase production was detected in K. pneumoniae isolates from 18 of 33 (54.5%) neonates. All-cause mortality was 13 of 33 (39.4%) and there was no significant difference in mortality between neonates treated with imipenem/cilastatin (6 of 17 or 35.3%) and neonates treated with piperacillin/tazobactam (6 of 13 or 46.2%). The duration of antimicrobial therapy and total hospital stay was similar between neonates who received imipenem/cilastatin and those that received piperacillin/tazobactam. This report suggests that piperacillin/tazobactam may be a useful antimicrobial agent in neonatal infections caused by beta-lactamase-producing organisms.
医院获得性肺炎克雷伯菌感染与新生儿的高死亡率相关，这些感染的抗菌治疗因多重耐药菌株的出现而变得复杂。这些病原体仅对少数抗菌药物敏感，其中一些不建议用于儿童。在本研究中，在一次疫情期间，我们三级新生儿病房用于治疗33例肺炎克雷伯菌感染新生儿的抗菌药物有：哌拉西林/他唑巴坦（13例）、亚胺培南/西司他丁（17例）、头孢噻肟（2例）和环丙沙星（1例）。在33例（54.5%）新生儿的肺炎克雷伯菌分离株中检测到超广谱β-内酰胺酶的产生。全因死亡率为33例中的13例（39.4%），接受亚胺培南/西司他丁治疗的新生儿（17例中的6例或35.3%）和接受哌拉西林/他唑巴坦治疗的新生儿（13例中的6例或46.2%）之间的死亡率没有显著差异。接受亚胺培南/西司他丁治疗的新生儿和接受哌拉西林/他唑巴坦治疗的新生儿之间的抗菌治疗持续时间和总住院时间相似。本报告表明，哌拉西林/他唑巴坦可能是治疗由产β-内酰胺酶的病原体引起的新生儿感染的一种有用的抗菌药物。
