Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death
Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death
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DOI：
10.1542/peds.2005-0179
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发表时间：
2006-01-01
期刊：
影响因子：
8
通讯作者：
Gerstmann, DR
中科院分区：
文献类型：
--
作者：
Clark, RH;Bloom, BT;Gerstmann, DR
背景我们以前曾报道过早产儿使用头孢菌素会增加随后发生真菌性败血症的风险。因此，我们建议使用氨苄青霉素和庆大霉素作为早期新生儿败血症的经验性覆盖，同时等待培养结果。描述新生儿重症监护病房新生儿出生后前3天内抗生素的使用情况，并评价2种不同抗生素方案治疗新生儿的结局。我们收集了一组出生新生儿，从我们的去识别管理数据库，谁记录暴露于氨苄青霉素在出生后的前3天。对同时接受头孢噻肟或庆大霉素治疗的婴儿进行评价，以确定与出院前死亡独立相关的因素，采用单变量和多变量分析。有128 914名新生儿被选作研究队列; 24 111名同时接受氨苄西林和头孢噻肟治疗，104 803名同时接受氨苄西林和庆大霉素治疗。Logistic模型显示，与接受氨苄西林/庆大霉素治疗的新生儿相比，接受氨苄西林/头孢噻肟治疗的新生儿更有可能死亡（校正比值比：1.5; 95%置信区间：1.4-1.7），并且不太可能出院回家或寄养。这一观察结果在所有估计的胎龄中均成立。与死亡独立相关的其他因素包括未成熟胎龄、入NICU当天需要辅助通气、围产期窒息或重大先天性畸形的指征以及报告的氨苄西林/头孢噻肟的使用。对于接受氨苄青霉素治疗的患者，与同时使用庆大霉素相比，出生后前3天内同时使用头孢噻肟可作为未识别因素的替代，或本身与死亡风险增加相关。
BACKGROUND. We reported previously that the use of cephalosporin among premature neonates increased the risk of subsequent fungal sepsis. As a result, we recommended that ampicillin and gentamicin be used as empiric coverage for early-onset neonatal sepsis while culture results are awaited.OBJECTIVES. To describe antibiotic use during the first 3 days after birth for neonates admitted to the NICU and to evaluate the outcomes for neonates treated with 2 different antibiotic regimens.METHODS. We assembled a cohort of inborn neonates, from our deidentified administrative database, who had documented exposure to ampicillin during the first 3 days after birth. Infants treated concurrently with cefotaxime or gentamicin were evaluated, to identify the factors that were associated independently with death before discharge, with both univariate and multivariate analyses.RESULTS. There were 128 914 neonates selected as the study cohort; 24 111 were treated concurrently with ampicillin and cefotaxime and 104 803 were treated concurrently with ampicillin and gentamicin. Logistic modeling showed that neonates treated with ampicillin/cefotaxime were more likely to die (adjusted odds ratio: 1.5; 95% confidence interval: 1.4-1.7) and were less likely to be discharged to home or foster care than were neonates treated with ampicillin/gentamicin. This observation was true across all estimated gestational ages. Other factors that were associated independently with death included immature gestational age, need for assisted ventilation on the day of admission to the NICU, indications of perinatal asphyxia or major congenital anomaly, and reported use of ampicillin/cefotaxime.CONCLUSIONS. For patients receiving ampicillin, the concurrent use of cefotaxime during the first 3 days after birth either is a surrogate for an unrecognized factor or is itself associated with an increased risk of death, compared with the concurrent use of gentamicin.